Rind D M, Safran C, Phillips R S, Slack W V, Calkins D R, Delbanco T L, Bleich H L
Center for Clinical Computing, Harvard Medical School, Boston, Massachusetts.
Proc Annu Symp Comput Appl Med Care. 1991:28-32.
We performed a prospective time-series study to determine whether computerized reminders to physicians about rising creatinine levels in hospitalized patients receiving nephrotoxic and renally excreted medications led to more rapid adjustment or discontinuation of those medications, and to evaluate physician acceptance of computerized reminders. Laboratory data were followed on 10,076 patients over 13,703 admissions generating 1104 events of rising creatinine levels during treatment with nephrotoxic or renally excreted medications. During the intervention period, medications were adjusted or discontinued an average of 21.1 hours sooner (p less than 0.0001) after such an event occurred when compared with the control period. This effect of the reminders was strongest for patients receiving renally excreted and mildly nephrotoxic medications. Of physicians who responded to a computerized survey, 53% said that the reminders had been helpful in the care of their patients, while 31% felt that the reminders were annoying. Seventy-three percent wished to continue receiving computerized reminders. We conclude that computerized reminders are well-accepted in our hospital and have a strong effect on physician behavior.
我们进行了一项前瞻性时间序列研究，以确定针对接受肾毒性和经肾脏排泄药物治疗的住院患者，向医生发出关于肌酐水平升高的计算机提醒，是否会促使这些药物更快得到调整或停用，并评估医生对计算机提醒的接受程度。在13703次住院治疗期间，我们对10076名患者的实验室数据进行了跟踪，在使用肾毒性或经肾脏排泄药物治疗期间，共发生1104例肌酐水平升高事件。与对照期相比，在干预期内，此类事件发生后，药物调整或停用的平均时间提前了21.1小时（p<0.0001）。提醒对接受经肾脏排泄且肾毒性较轻药物治疗的患者效果最为显著。在回复计算机化调查的医生中，53%表示提醒对照顾患者有帮助，而31%觉得提醒很烦人。73%的医生希望继续收到计算机提醒。我们得出结论，计算机提醒在我们医院得到了很好的接受，并且对医生的行为有很大影响。
