Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2006 Jul-Aug;13(4):378-84.
doi: 10.1197/jamia.M2049. Epub 2006 Apr 18.

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

Jessina C McGregor  1 , Elizabeth Weekes, Graeme N Forrest, Harold C Standiford, Eli N Perencevich, Jon P Furuno, Anthony D Harris
Affiliations
Randomized Controlled Trial

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

Jessina C McGregor et al. J Am Med Inform Assoc. 2006 Jul-Aug.

Abstract

Objective: Many hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness and cost-effectiveness of a computerized clinical decision support system for the management of antimicrobial utilization.

Design: A randomized controlled trial in adult inpatients between May 10 and August 3, 2004. Antimicrobial utilization was managed by an existing AMT using the system in the intervention arm and without the system in the control arm. The system was developed to alert the AMT of potentially inadequate antimicrobial therapy.

Measurements: Outcomes assessed were hospital antimicrobial expenditures, mortality, length of hospitalization, and time spent managing antimicrobial utilization.

Results: The AMT intervened on 359 (16%) of 2,237 patients in the intervention arm and 180 (8%) of 2,270 in the control arm, while spending approximately one hour less each day on the intervention arm. Hospital antimicrobial expenditures were $285,812 in the intervention arm and $370,006 in the control arm, for a savings of $84,194 (23%), or $37.64 per patient. No significant difference was observed in mortality (3.26% vs. 2.95%, p = 0.55) or length of hospitalization (3.84 vs. 3.99 days, p = 0.38).

Conclusion: Use of the system facilitated the management of antimicrobial utilization by allowing the AMT to intervene on more patients receiving inadequate antimicrobial therapy and to achieve substantial time and cost savings for the hospital. This is the first study that demonstrates in a patient-randomized controlled trial that computerized clinical decision support systems can improve existing antimicrobial management programs.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Profile of Study Participants Abbreviations: UMMC, University of Maryland Medical Center; AMT, antimicrobial management team; MRN, medical record number Definition: system refers to the intervention, a web-based, computerized clinical decision support system aAMT-managed wards include all hospital wards except shock trauma, cancer, pediatric wards
See this image and copyright information in PMC

References

    1. Shlaes DM, Gerding DN, John Jr JF, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistanceguidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18(4):275-291Apr. - PubMed
    1. Paskovaty A, Pflomm JM, Myke N, Seo SK. A multidisciplinary approach to antimicrobial stewardshipevolution into the 21st century. Int J Antimicrob Agents 2005;25(1):1-10Jan. - PubMed
    1. Minooee A, Rickman LS. Expanding the role of the infection control professional in the cost-effective use of antibiotics Am J Infect Control 2000;28(1):57-65Feb. - PubMed
    1. Bearden DT, Allen GP. Impact of Antimicrobial Control Programs on Patient Outcomes Dis Manag Health Outcomes 2003;11(11):723-736.
    1. Paterson DL. The role of antimicrobial management programs in optimizing antibiotic prescribing within hospitals Clin Infect Dis 2006;42(Suppl 2):S90-S95Jan 15. - PubMed

Publication types

Substances