Rs. Evans et al., A COMPUTER-ASSISTED MANAGEMENT PROGRAM FOR ANTIBIOTICS AND OTHER ANTIINFECTIVE AGENTS, The New England journal of medicine, 338(4), 1998, pp. 232-238
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.