A COMPUTER-ASSISTED MANAGEMENT PROGRAM FOR ANTIBIOTICS AND OTHER ANTIINFECTIVE AGENTS

Background and Methods Optimal decisions about the use of antibiotics and other antiinfective agents in critically ill patients require acce ss to a large amount of complex information. We have developed a compu terized decision-support program linked to computer-based patient reco rds that can assist physicians in the use of antiinfective agents and improve the quality of care. This program presents epidemiologic infor mation, along with detailed recommendations and warnings. The program recommends antiinfective regimens and courses of therapy for particula r patients and provides immediate feedback. We prospectively studied t he use of the computerized antiinfectives-management program for one y ear in a 12-bed intensive care unit. Results During the intervention p eriod, all 545 patients admitted were cared for with the aid of the an tiinfectives-management program. Measures of processes and outcomes we re compared with those for the 1136 patients admitted to the same unit during the two years before the intervention period. The use of the p rogram led to significant reductions in orders for drugs to which the patients had reported allergies (35, vs. 146 during the preinterventio n period; P<0.01), excess drug dosages (87 vs. 405, P<0.01), and antib iotic-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 a gents (4 vs. 28, P<0.02). In analyses of patients who received antiinf ective 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 rec eive the recommended regimens (n=195) and those in the preintervention cohort (n=766), in the cost of an tiinfective agents (adjusted mean, $102 vs. $427 and $340, respectively; P<0.001), in total hospital cost s (adjusted mean, $26,315 vs. $44,865 and $35,283; P<0.001), and in th e length of the hospital stay (adjusted mean, 10.0 vs. 16.7 and 12.9 d ays; P<0.001). Conclusions A computerized antiinfectives-management pr ogram can improve the quality of patient care and reduce costs. (C) 19 98, Massachusetts Medical Society.