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.


METHODS
The conclusions produced by an expert system developed to detect and manage infections were presented to the attending clinicians in a pediatric hospital to determine whether this information could improve detection and management. Clinician interventions were compared before and after the implementation of the system.


METHODS
The responses of the clinicians (staff physicians, physician assistants, and nurse practitioners) to the reminders were determined by review of paper medical charts. Main outcome measures were the number of suggestions to treat and manage infections that were followed before and after the implementation of COMPISS (Computerized Pediatric Infection Surveillance 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 clinicians' treatment strategies before and after implementation of the system (P: > 0.33 for clinicians working in the emergency room and P: > 0.45 for clinicians working in the pediatric intensive care unit). The questionnaire results showed that the respondents appreciated the information presented by the system.


CONCLUSIONS
The computer-generated reminders about infections were unable to influence the practice patterns of clinicians. The methodologic problems that may have contributed to this negative result are discussed.
University of Utah, Salt Lake City, Utah. lpbrocha@ihc.com
B H
BH
Rocha
J C
JC
Christenson
R S
RS
Evans
R M
RM
Gardner
D003428:Cross Infection / Q000175:diagnosis* / Q000628:therapy; D020000:Decision Support Systems, Clinical; D004636:Emergency Service, Hospital; D005103:Expert Systems; D006748:Hospital Departments; D015278:Intensive Care Units, Pediatric; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017010:Reminder Systems / Q000706:statistics & numerical data; D012107:Research Design; D011795:Surveys and Questionnaires; D014589:Utah