title: Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial.
abstract: OBJECTIVE
  Many hospitals utilize antimicrobial management teams (AMTs) to improve patient care. However, most function with minimal computer support. We evaluated the effectiveness and cost-effectiveness of a computerized clinical decision support system for the management of antimicrobial utilization.
  
  
  METHODS
  A randomized controlled trial in adult inpatients between May 10 and August 3, 2004. Antimicrobial utilization was managed by an existing AMT using the system in the intervention arm and without the system in the control arm. The system was developed to alert the AMT of potentially inadequate antimicrobial therapy.
  
  
  METHODS
  Outcomes assessed were hospital antimicrobial expenditures, mortality, length of hospitalization, and time spent managing antimicrobial utilization.
  
  
  RESULTS
  The AMT intervened on 359 (16%) of 2,237 patients in the intervention arm and 180 (8%) of 2,270 in the control arm, while spending approximately one hour less each day on the intervention arm. Hospital antimicrobial expenditures were $285,812 in the intervention arm and $370,006 in the control arm, for a savings of $84,194 (23%), or $37.64 per patient. No significant difference was observed in mortality (3.26% vs. 2.95%, p = 0.55) or length of hospitalization (3.84 vs. 3.99 days, p = 0.38).
  
  
  CONCLUSIONS
  Use of the system facilitated the management of antimicrobial utilization by allowing the AMT to intervene on more patients receiving inadequate antimicrobial therapy and to achieve substantial time and cost savings for the hospital. This is the first study that demonstrates in a patient-randomized controlled trial that computerized clinical decision support systems can improve existing antimicrobial management programs.
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, 100 North Greene Street, Lower Level, Baltimore, MD 21201, USA. jmcgrego@epi.umaryland.edu
authors.forename: Jessina C
authors.initials: JC
authors.lastname: McGregor
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weekes
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Forrest
authors.forename: Harold C
authors.initials: HC
authors.lastname: Standiford
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.forename: Jon P
authors.initials: JP
authors.lastname: Furuno
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D020000:Decision Support Systems, Clinical; D004360:Drug Therapy, Computer-Assisted; D006300:Health Services Misuse; D006801:Humans; D017010:Reminder Systems
chemical_list: D000890:Anti-Infective Agents