title: Clinical decision support system and incidence of delirium in cognitively impaired older adults transferred to intensive care.
abstract: BACKGROUND
  Elderly patients with cognitive impairment are at increased risk of developing delirium, especially in the intensive care unit.
  
  
  OBJECTIVE
  To evaluate the efficacy of a computer-based clinical decision support system that recommends consulting a geriatrician and discontinuing use of urinary catheters, physical restraints, and unnecessary anticholinergic drugs in reducing the incidence of delirium.
  
  
  METHODS
  Data for a subgroup of patients enrolled in a large clinical trial who were transferred to the intensive care units of a tertiary-care, urban public hospital in Indianapolis were analyzed. Data were collected on frequency of orders for consultation with a geriatrician; discontinuation of urinary catheterization, physical restraints, or anticholinergic drugs; and the incidence of delirium.
  
  
  RESULTS
  The sample consisted of 60 adults with cognitive impairment. Mean age was 74.6 years; 45% were African American, and 52% were women. No differences were detected between the intervention and the control groups in orders for consultation with a geriatrician (33% vs 40%; P = .79) or for discontinuation of urinary catheters (72% vs 76%; P = .99), physical restraints (12% vs 0%; P=.47), or anticholinergic drugs (67% vs 36%; P=.37). The 2 groups did not differ in the incidence of delirium (27% vs 29%; P = .85).
  
  
  CONCLUSIONS
  Use of a computer-based clinical decision support system may not be effective in changing prescribing patterns or in decreasing the incidence of delirium.
authors: Regenstrief Institute, Inc, Indianapolis, IN, USA. bakhan@iupui.edu
authors: Babar A
authors: BA
authors: Khan
authors: Enrique
authors: E
authors: Calvo-Ayala
authors: Noll
authors: N
authors: Campbell
authors: Anthony
authors: A
authors: Perkins
authors: Ruxandra
authors: R
authors: Ionescu
authors: Jason
authors: J
authors: Tricker
authors: Tiffany
authors: T
authors: Campbell
authors: Mohammed
authors: M
authors: Zawahiri
authors: John D
authors: JD
authors: Buckley
authors: Mark O
authors: MO
authors: Farber
authors: Malaz A
authors: MA
authors: Boustani
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000009:adverse effects; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology*; D020000:Decision Support Systems, Clinical; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007196:Indiana; D007362:Intensive Care Units; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D016032:Randomized Controlled Trials as Topic; D012149:Restraint, Physical / Q000009:adverse effects; D012307:Risk Factors; D062885:Urinary Catheters / Q000009:adverse effects
chemical_list: D018680:Cholinergic Antagonists
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