Clinicians' response to computerized detection of infections

Objective: To analyze whether computer-generated reminders about infections could influence clinicians' practice patterns and consequently improve the detection and management of nosocomial infections. Design: The conclusions produced by an expert system developed to detect an d manage infections were presented to the attending clinicians in a pediatr ic hospital to determine whether this information could improve detection a nd management. Clinician interventions were compared before and after the i mplementation of the system. Measurements: The responses of the clinicians (staff physicians, physician assistants, and nurse practitioners) to the reminders were determined by re view of paper medical charts. Main outcome measures were the number of sugg estions to treat and manage infections that were followed before and after the implementation of COMPISS (Computerized Pediatric Infection Surveillanc e System). The clinicians' opinions about the system were assessed by means of a paper questionnaire distributed following the experiment. Results: The results failed to show a statistical difference between the cl inicians' treatment strategies before and after implementation of the syste m (P > 0.33 for clinicians working in the emergency room and P > 0.45 for c linicians working in the pediatric intensive care unit). The questionnaire results showed that the respondents appreciated the information presented b y the system. Conclusion: The computer-generated reminders about infections were unable t o influence the practice patterns of clinicians. The methodologic problems that may have contributed to this negative result are discussed.