title: Tight glycemic control and computerized decision-support systems: a systematic review.
abstract: OBJECTIVE
  To identify and summarize characteristics of computerized decision-support systems (CDSS) for tight glycemic control (TGC) and to review their effects on the quality of the TGC process in critically ill patients.
  
  
  METHODS
  We searched Medline (1950-2008) and included studies on critically ill adult patients that reported original data from a clinical trial or observational study with a main objective of evaluating a given TGC protocol with a CDSS.
  
  
  RESULTS
  Seventeen articles met the inclusion criteria. Eleven out of seventeen studies evaluated the effect of a new TGC protocol that was introduced simultaneously with a CDSS implementation. Most of the reported CDSSs were stand-alone, were not integrated in any other clinical information systems and used the "passive" mode requiring the clinician to ask for advice. Different implementation sites, target users, and time of advice were used, depending on local circumstances. All controlled studies reported on at least one quality indicator of the blood glucose regulatory process that was improved by introducing the CDSS. Nine out of ten controlled studies either did not report on the number of hypoglycemia events (one study), or reported on no change (six studies) or even a reduction in this number (two studies).
  
  
  CONCLUSIONS
  While most studies evaluating the effect of CDSS on the quality of the TGC process found improvement when evaluated on the basis of the quality indicators used, it is impossible to define the exact success factors, because of simultaneous implementation of the CDSS with a new or modified TGC protocol and the hybrid solutions used to integrate the CDSS into the clinical workflow.
authors: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands. s.eslami@amc.uva.nl
authors: Saeid
authors: S
authors: Eslami
authors: Ameen
authors: A
authors: Abu-Hanna
authors: Evert
authors: E
authors: de Jonge
authors: Nicolette F
authors: NF
authors: de Keizer
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003422:Critical Care; D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical; D038321:Glycemic Index; D006801:Humans
chemical_list: D001786:Blood Glucose