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Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial

^a Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD
^b University of Maryland Medical Center Baltimore, MD
^c Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD
^d VA Maryland Healthcare System, Baltimore, MD.

^_* Correspondence and reprints: Jessina C. McGregor, PhD, Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, 100 North Greene Street, Lower Level, Baltimore, MD 21201 (Email: jmcgrego{at}epi.umaryland.edu).

Received for publication: 01/06/06; accepted for publication: 04/07/06.

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.

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