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Submitted on January 26, 2005
Accepted on March 24, 2005
Affiliation of the authors: 1 Centre for Health Informatics, University of New South Wales, Sydney, NSW, Australia; 2 Centre for Infectious Diseases and Microbiology and Intensive Care Unit, Westmead Hospital, Westmead; University of Sydney, NSW, Australia; 3 University of Sydney and Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
* To whom correspondence should be addressed.
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 ICU at a tertiary referral hospital.
Measurements System impact was assessed in a prospective `before-after' cohort trial lasting 12 months. Outcome measures were defined daily doses (DDD) of antibiotics per 1000 patient days, patient length of stay and mortality.
Results The number of admissions, APACHE II and SAPS II scores for patients in pre-intervention 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 1767 DDD to 1458 DDD per 1000 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 beta-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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