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Previous Volume 338:232-238 January 22, 1998 Number 4 Next

	Full Text PDF Editorial by Garibaldi, R. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods Optimal decisions about the use of antibiotics and other antiinfective agents in critically ill patients require access to a large amount of complex information. We have developed a computerized decision-support program linked to computer-based patient records that can assist physicians in the use of antiinfective agents and improve the quality of care. This program presents epidemiologic information, along with detailed recommendations and warnings. The program recommends antiinfective regimens and courses of therapy for particular patients and provides immediate feedback. We prospectively studied the use of the computerized antiinfectives-management program for one year in a 12-bed intensive care unit.

Results During the intervention period, all 545 patients admitted were cared for with the aid of the antiinfectives-management program. Measures of processes and outcomes were compared with those for the 1136 patients admitted to the same unit during the two years before the intervention period. The use of the program led to significant reductions in orders for drugs to which the patients had reported allergies (35, vs. 146 during the preintervention period; P<0.01), excess drug dosages (87 vs. 405, P<0.01), and antibiotic-susceptibility mismatches (12 vs. 206, P<0.01). There were also marked reductions in the mean number of days of excessive drug dosage (2.7 vs. 5.9, P<0.002) and in adverse events caused by antiinfective agents (4 vs. 28, P<0.02). In analyses of patients who received antiinfective agents, those treated during the intervention period who always received the regimens recommended by the computer program (n = 203) had significant reductions, as compared with those who did not always receive the recommended regimens (n = 195) and those in the preintervention cohort (n = 766), in the cost of antiinfective agents (adjusted mean, $102 vs. $427 and $340, respectively; P<0.001), in total hospital costs (adjusted mean, $26,315 vs. $44,865 and $35,283; P<0.001), and in the length of the hospital stay (adjusted mean, 10.0 vs. 16.7 and 12.9 days; P<0.001).

Conclusions A computerized antiinfectives-management program can improve the quality of patient care and reduce costs.

Source Information

From the Departments of Clinical Epidemiology (R.S.E., S.L.P., D.C.C., J.F.L., J.P.B.), Critical Care (T.P.C., L.K.W., J.F.O.), and Medical Informatics (R.S.E.), LDS Hospital, Salt Lake City.

Address reprint requests to Dr. Evans at the Department of Clinical Epidemiology, LDS Hospital, 8th Ave. and C St., Salt Lake City, UT 84143.

Full Text of this Article

Related Letters:

A Computer-Assisted Management Program for Antiinfective Agents
Majumdar S. R., Ross-Degnan D., Soumerai S. B., Cole C. L., Johnson J. R., Duncan R. A., Burke J. P., Classen D. C., Evans R. S.
Extract | Full Text  
N Engl J Med 1998; 338:1775-1776, Jun 11, 1998. Correspondence

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