title: [Contribution of information technologies to assess and improve professional practice: example of management of surgical antibiotic prophylaxis].
abstract: BACKGROUND
  Information technologies appear to be interesting tools to assess and improve professional practices. In that setting, the management of surgical antibiotic prophylaxis represents an appropriate clinical area for using and evaluating such a tool. Despite the existence of guidelines in one hand and the demonstrated interest for a strict application of recommendations in the other hand, some irregularities in the management of surgical antibiotic prophylaxis remain in France in 2010.
  
  
  OBJECTIVE
  Since we have had computer systems in our department for several years, we performed an evaluation of practice to assess the impact of both the computer-based help and the updating of knowledge in physicians as tools to improve the application of guidelines for surgical antibiotic prophylaxis.
  
  
  METHODS
  Clinical audits.
  
  
  METHODS
  Three clinical audits have therefore been performed before an implementation of computer-based help for clinical decisions and a clinical update for physicians, immediately after, and two years after this combined procedure (2322, 2678 and 2863 patients, respectively).
  
  
  RESULTS
  There was an enhancement of clinical practices and compliance to guidelines secondary to the beginning of computer-based prescription (55 to 81%, P<0.05). However, a weaning effect was observed with longer intervals between clinical update and surgical procedure, in association with increased omissions of antibiotic prophylaxis.
  
  
  CONCLUSIONS
  Computer-based help for clinical decision and prescription seems to be a useful tool for surgical antibiotic prophylaxis but it should be accompanied by direct regular educational measures to update protocols and databases.
authors.affiliation: Département d'anesthésie-réanimation, hôpital Édouard-Herriot, place d'Arsonval, 69437 Lyon cedex 03, France. laure.fayolle-pivot@chu-lyon.fr
authors.forename: L
authors.initials: L
authors.lastname: Fayolle-Pivot
authors.forename: P-F
authors.initials: PF
authors.lastname: Wey
authors.forename: F
authors.initials: F
authors.lastname: Petitjeans
authors.forename: M
authors.initials: M
authors.lastname: Puidupin
authors.forename: B
authors.initials: B
authors.lastname: Allaouchiche
authors.forename: J
authors.initials: J
authors.lastname: Escarment
mesh_terms: D000761:Anesthesia Department, Hospital; D019072:Antibiotic Prophylaxis; D003657:Decision Making; D004342:Drug Hypersensitivity / Q000517:prevention & control; D011307:Drug Prescriptions; D004697:Endocarditis, Bacterial / Q000517:prevention & control; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008490:Medical Informatics; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011292:Premedication; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative