title: Computer-assisted decision support for changing practice in severe sepsis and septic shock.
abstract: Computer-assisted decision support systems (CDSS) are designed to improve infection management. The aim of this prospective, clinical pre- and post-intervention study was to investigate the influence of CDSS on infection management of severe sepsis and septic shock in intensive care units (ICUs). Data were collected for a total of 180 days during two study periods in 2006 and 2007. Of the 186 patients with severe sepsis or septic shock, 62 were stratified into a low adherence to infection management standards group (LAG) and 124 were stratified into a high adherence group (HAG). ICU mortality was significantly increased in LAG versus HAG patients (Kaplan-Meier analysis). Following CDSS implementation, adherence to standards increased significantly by 35%, paralleled with improved diagnostics, more antibiotic-free days and a shortened time until antibiotics were administered. In conclusion, adherence to infection standards is beneficial for patients with severe sepsis or septic shock and CDSS is a useful tool to aid adherence.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Tafelski
authors.forename: I
authors.initials: I
authors.lastname: Nachtigall
authors.forename: M
authors.initials: M
authors.lastname: Deja
authors.forename: A
authors.initials: A
authors.lastname: Tamarkin
authors.forename: T
authors.initials: T
authors.lastname: Trefzer
authors.forename: E
authors.initials: E
authors.lastname: Halle
authors.forename: K D
authors.initials: KD
authors.lastname: Wernecke
authors.forename: C
authors.initials: C
authors.lastname: Spies
mesh_terms: D000368:Aged; D017076:Computer-Aided Design; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate