Research Paper: Clinicians' Response to Computerized Detection of Infections

Objective: To analyze whether computer-generated reminders about infections could influence clinicians' practice patterns and consequently improve the detection and manage- ment of nosocomial infections. Design: The conclusions produced by an expert system developed to detect and manage infections were presented to the attending clinicians in a pediatric hospital to determine whether this infor- mation could improve detection and management. Clinician interventions were compared before and after the implementation of the system. Measurements: The responses of the clinicians (staff physicians, physician assistants, and nurse practitioners) to the reminders were determined by review of paper medical charts. Main outcome measures were the number of suggestions to treat and manage infections that were followed before and after the implementation of COMPISS (Computerized Pediatric Infection Surveillance System). The clinicians' opinions about the system were assessed by means of a paper questionnaire distrib- uted following the experiment. Results: The results failed to show a statistical difference between the clinicians' treatment strategies before and after implementation of the system (P > 0.33 for clinicians working in the emergency room and P > 0.45 for clinicians working in the pediatric intensive care unit). The questionnaire results showed that the respondents appreciated the information presented by the system. Conclusion: The computer-generated reminders about infections were unable to influence the practice patterns of clinicians. The methodologic problems that may have contributed to this negative result are discussed. � J Am Med Inform Assoc. 2001;8:117-125.

[1]  M G Kahn,et al.  An expert system for culture-based infection control surveillance. , 1993, Proceedings. Symposium on Computer Applications in Medical Care.

[2]  C. McDonald.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[3]  KAVEH G. SHOJANIA,et al.  Research Paper: Reducing Vancomycin Use Utilizing a Computer Guideline: Results of a Randomized Controlled Trial , 1998, J. Am. Medical Informatics Assoc..

[4]  Charles P. Friedman,et al.  Evaluation Methods in Medical Informatics , 1997, Computers and Medicine.

[5]  R. Haley,et al.  The nationwide nosocomial infection rate. A new need for vital statistics. , 1985, American journal of epidemiology.

[6]  D. Spiegelhalter,et al.  Evaluating medical expert systems: what to test and how? , 1990, Medical informatics = Medecine et informatique.

[7]  W. Ceusters,et al.  Quality assurance, infection surveillance, and hospital information systems: avoiding the Bermuda Triangle. , 1994, Infection control and hospital epidemiology.

[8]  R. Trevino,et al.  Nosocomial infections in the pediatric intensive care unit. , 1994, Pediatric clinics of North America.

[9]  R. Haynes,et al.  Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. , 1998, JAMA.

[10]  P. Gaunt,et al.  Information in infection control. , 1991, The Journal of hospital infection.

[11]  W. Scheckler,et al.  Recommended practices for surveillance , 1998 .

[12]  D M Rind,et al.  Designing studies of computer-based alerts and reminders. , 1995, M.D. computing : computers in medical practice.

[13]  R M Gardner,et al.  Development of a computerized infectious disease monitor (CIDM). , 1985, Computers and biomedical research, an international journal.

[14]  David C Classen,et al.  Evaluation of a Computer-Assisted Antibiotic-Dose Monitor , 1999, The Annals of pharmacotherapy.

[15]  C. McDonald,et al.  Reminders to physicians from an introspective computer medical record. A two-year randomized trial. , 1984, Annals of internal medicine.

[16]  R. Haynes,et al.  Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research , 1994, Annals of Internal Medicine.

[17]  J R Scherrer,et al.  Automatic Alerts for Methicillin-Resistant Staphylococcus aureus Surveillance and Control: Role of a Hospital Information System , 1996, Infection Control & Hospital Epidemiology.

[18]  C. Safran,et al.  Effect of computer-based alerts on the treatment and outcomes of hospitalized patients. , 1994, Archives of internal medicine.

[19]  R M Gardner,et al.  Computerized detection of nosocomial infections in newborns. , 1994, Proceedings. Symposium on Computer Applications in Medical Care.

[20]  R. Lodha,et al.  Nosocomial infections in pediatric intensive care units , 2001, Indian journal of pediatrics.

[21]  G J Kuperman,et al.  A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. , 1999, The American journal of medicine.