EFFECT OF COMPUTER-BASED ALERTS ON THE TREATMENT AND OUTCOMES OF HOSPITALIZED-PATIENTS

Background: Hospital computing systems play an important part in the c ommunication of clinical information to physicians. We sought to deter mine whether computer-based alerts for hospitalized patients can affec t physicians' behavior and improve patients' outcomes. Methods: We per formed a prospective time-series study to determine whether computeriz ed alerts to physicians about rising creatinine levels in hospitalized patients receiving nephrotoxic or renally excreted medications led to more rapid adjustment or discontinuation of those medications, and to determine whether such alerts protected renal function. Results: Labo ratory data were observed for 20 228 hospitalizations, with documentat ion of 1573 events (instances of rising creatinine levels during treat ment with a nephrotoxic or renally excreted drug). During the interven tion period, doses were adjusted or medications discontinued an averag e of 21.6 hours sooner after such an event (P<.0001). For patients rec eiving nephrotoxic medications during the intervention period, the rel ative risk of serious renal impairment was 0.45 (95% confidence interv al, 0.22 to 0.94) as compared with the control period, and the mean se rum creatinine level was 14.1 mu mol/L (0.16 mg/dL) lower on day 3 (P< .01) and 25.6 mu mol/L (0.29 mg/dL) lower on day 7 (P<.05) after an ev ent. Forty-four percent of physicians who responded to a questionnaire said that the alerts had been helpful in the care of their patients, whereas 28% found them annoying. Sixty-five percent wished to continue receiving alerts. Conclusions: Computer-based alerts regarding patien ts with rising creatinine levels affect physician behavior, prevent se rious renal impairment, preserve renal function, and are accepted by c linicians.