Evans R S, Pestotnik S L, Classen D C, Clemmer T P, Weaver L K, Orme J F, Lloyd J F, Burke J P
Department of Clinical Epidemiology, LDS Hospital, Salt Lake City, UT 84143, USA.
N Engl J Med. 1998 Jan 22;338(4):232-8. doi: 10.1056/NEJM199801223380406.
Optimal decisions about the use of antibiotics and other antiinfective agents in critically ill patients require access to a large amount of complex information. We have developed a computerized decision-support program linked to computer-based patient records that can assist physicians in the use of antiinfective agents and improve the quality of care. This program presents epidemiologic information, along with detailed recommendations and warnings. The program recommends antiinfective regimens and courses of therapy for particular patients and provides immediate feedback. We prospectively studied the use of the computerized antiinfectives-management program for one year in a 12-bed intensive care unit.
During the intervention period, all 545 patients admitted were cared for with the aid of the antiinfectives-management program. Measures of processes and outcomes were compared with those for the 1136 patients admitted to the same unit during the two years before the intervention period. The use of the program led to significant reductions in orders for drugs to which the patients had reported allergies (35, vs. 146 during the preintervention period; P<0.01), excess drug dosages (87 vs. 405, P<0.01), and antibiotic-susceptibility mismatches (12 vs. 206, P<0.01). There were also marked reductions in the mean number of days of excessive drug dosage (2.7 vs. 5.9, P<0.002) and in adverse events caused by antiinfective agents (4 vs. 28, P<0.02). In analyses of patients who received antiinfective agents, those treated during the intervention period who always received the regimens recommended by the computer program (n=203) had significant reductions, as compared with those who did not always receive the recommended regimens (n= 195) and those in the preintervention cohort (n = 766), in the cost of antiinfective agents (adjusted mean, $102 vs. $427 and $340, respectively; P<0.001), in total hospital costs (adjusted mean, $26,315 vs. $44,865 and $35,283; P<0.001), and in the length of the hospital stay days (adjusted mean, 10.0 vs. 16.7 and 12.9; P<0.001). CONCLUSIONS; A computerized antiinfectives-management program can improve the quality of patient care and reduce costs.
对于重症患者使用抗生素及其他抗感染药物做出最佳决策需要获取大量复杂信息。我们开发了一个与基于计算机的患者记录相链接的计算机化决策支持程序，该程序可协助医生使用抗感染药物并提高医疗质量。此程序提供流行病学信息以及详细的建议和警示。该程序针对特定患者推荐抗感染治疗方案和疗程，并提供即时反馈。我们在一个拥有12张床位的重症监护病房对计算机化抗感染管理程序的使用进行了为期一年的前瞻性研究。
在干预期间，收治的所有545例患者均借助抗感染管理程序进行治疗。将过程和结果指标与干预期前两年在同一病房收治的1136例患者的指标进行比较。使用该程序后，患者报告有过敏反应的药物医嘱显著减少（35例，而干预前期为146例；P<0.01），过量用药剂量显著减少（87例 vs. 405例，P<0.01），抗生素敏感性不匹配情况显著减少（12例 vs. 206例，P<0.01）。过量用药的平均天数也显著减少（2.7天 vs. 5.9天，P<0.002），抗感染药物引起的不良事件也显著减少（4例 vs. 28例，P<0.02）。在接受抗感染药物治疗的患者分析中，与未始终接受计算机程序推荐方案的患者（n = 195）以及干预前期队列患者（n = 766）相比，干预期内始终接受计算机程序推荐方案治疗的患者（n =
