Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care

Vitali Sintchenko, Jonathan R. Iredell, Gwendolyn L. Gilbert, Enrico Coiera

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: This study assessed the effect of a handheld computer-based decision support system (DSS) on antibiotic use and patient outcomes in a critical care unit. Design: A DSS containing four types of evidence (patient microbiology reports, local antibiotic guidelines, unit-specific antibiotic susceptibility data for common bacterial pathogens, and a clinical pulmonary infection score calculator) was developed and implemented on a handheld computer for use in the intensive care unit at a tertiary referral hospital. System impact was assessed in a prospective "before/after" cohort trial lasting 12 months. Outcome measures were defined daily doses (DDDs) of antibiotics per 1,000 patient-days, patient length of stay, and mortality. Results: The number of admissions, APACHE (Acute Physiology, Age, and Chronic Health Evaluation) II and SAPS (Simplified Acute Physiology Score) II for patients in preintervention, and intervention (DSS use) periods were statistically comparable. The mean patient length of stay and the use of antibiotics in the unit during six months of the DSS use decreased from 7.15 to 6.22 bed-days (p = 0.02) and from 1,767 DDD to 1,458 DDD per 1,000 patient-days (p = 0.04), respectively, with no change in mortality. The DSS was accessed 674 times during 168 days of the trial. Microbiology reports and antibiotic guidelines were the two most commonly used (53% and 22.5%, respectively) types of evidence. The greatest reduction was observed in the use of β-lactamase-resistant penicillins and vancomycin. Conclusion: Handheld computer-based decision support contributed to a significant reduction in patient length of stay and antibiotic prescribing in a critical care unit.

LanguageEnglish
Pages398-402
Number of pages5
JournalJournal of the American Medical Informatics Association
Volume12
Issue number4
DOIs
Publication statusPublished - Jul 2005
Externally publishedYes

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Handheld Computers
Critical Care
Length of Stay
Anti-Bacterial Agents
Microbiology
Guidelines
APACHE
Mortality
Vancomycin
beta-Lactamases
Tertiary Care Centers
Penicillins
Intensive Care Units
Outcome Assessment (Health Care)
Lung

Cite this

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title = "Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care",
abstract = "Objective: This study assessed the effect of a handheld computer-based decision support system (DSS) on antibiotic use and patient outcomes in a critical care unit. Design: A DSS containing four types of evidence (patient microbiology reports, local antibiotic guidelines, unit-specific antibiotic susceptibility data for common bacterial pathogens, and a clinical pulmonary infection score calculator) was developed and implemented on a handheld computer for use in the intensive care unit at a tertiary referral hospital. System impact was assessed in a prospective {"}before/after{"} cohort trial lasting 12 months. Outcome measures were defined daily doses (DDDs) of antibiotics per 1,000 patient-days, patient length of stay, and mortality. Results: The number of admissions, APACHE (Acute Physiology, Age, and Chronic Health Evaluation) II and SAPS (Simplified Acute Physiology Score) II for patients in preintervention, and intervention (DSS use) periods were statistically comparable. The mean patient length of stay and the use of antibiotics in the unit during six months of the DSS use decreased from 7.15 to 6.22 bed-days (p = 0.02) and from 1,767 DDD to 1,458 DDD per 1,000 patient-days (p = 0.04), respectively, with no change in mortality. The DSS was accessed 674 times during 168 days of the trial. Microbiology reports and antibiotic guidelines were the two most commonly used (53{\%} and 22.5{\%}, respectively) types of evidence. The greatest reduction was observed in the use of β-lactamase-resistant penicillins and vancomycin. Conclusion: Handheld computer-based decision support contributed to a significant reduction in patient length of stay and antibiotic prescribing in a critical care unit.",
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Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care. / Sintchenko, Vitali; Iredell, Jonathan R.; Gilbert, Gwendolyn L.; Coiera, Enrico.

In: Journal of the American Medical Informatics Association, Vol. 12, No. 4, 07.2005, p. 398-402.

Research output: Contribution to journalArticleResearchpeer-review

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