Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial

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An article published in the Journal of the American Medical Informatics Association by McGregor, J.C., et al. focused on evaluating the impact of a computer based decision support system in reducing the inappropriate use of antimicrobials. The use of Antimicrobial Management Teams (AMT) are implemented in hospitals to control and manage the growing problem of antimicrobial resistance and ensure a high quality of patient care by optimizing antimicrobial utilization. Per the authors the team is normally made up of a physician who rounds daily on patients and a pharmacist. Most of these teams are functioning with minimal computer support.

This study focused on the use of a web-based decision support system designed specifically for this type of clinical monitoring which was designed with input from the clinical stakeholders. The study consisted of a randomized controlled trial of patients admitted to wards managed by the antimicrobial management team, which excluded the follow wards: shock trauma, cancer, and pediatrics. Members of the team would log into the decision support system each week to review the patient alerts that were triggered for patients that may require change in their antimicrobial therapy. There were 32 alerts in total and they were designed to detect all scenarios of potentially inappropriate or inadequate antimicrobial use. After review the alert the team could review additional patient information as it was uploaded from the hospital information system nightly. If additional information was needed the patients paper chart would serve as the final resource. The study did not record the frequency of the number of times the chart was consulted the estimate is approximately 20%.

The trial lasted approximately three months May 10, 2004 to August 3, 2004. The study was concluded following the evaluation of the interim results by the Medical Director for Infection Control and Antimicrobial Effectiveness who decided to implement the use of the system in all patient wards managed by the antimicrobial management team. The study showed that the University of Maryland saved $84,194 on antimicrobials utilizing the decision support system. Additionally, there was a 31% savings about $60,288 on the purchase of restricted antimicrobial drugs. Utilizing the Red Book wholesale prices the study further documented that there was a wholesale antimicrobial cost savings of $917,314 (15.9%).

Comment

The fact that this system in three months has proven to have financial benefits for this organization isn’t necessarily true for every hospital. This system was designed specifically to meet the needs of this organization with direct input from the individuals who utilized the system. A fact that should be considered when reviewing this study is that many medical centers very in their staff’s knowledge and experience with clinical information systems. Given the short evaluation time and the unique scenario in which users were allowed direct input for system design I can see where additional studies for this type of decisions support systems could be beneficial.

References

  1. http://www.ncbi.nlm.nih.gov/pubmed/16622162