Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review

Objective: To examine the effect of computerized decision support systems (CDSSs) on nursing performance and patient outcomes. Method: Fifteen databases, including Medline and CINAHL, were searched up to May 2006 together with reference lists of included studies and relevant reviews. Randomized controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies that assessed the effects of CDSS use by nurses in a clinical setting on measurable professional and/or patient outcomes were included. Results: Eight studies, three comparing nurses using CDSS with nurses not using CDSS and five comparing nurses using CDSS with other health professionals not using CDSS, were included. Risk of contamination was a concern in four studies. The effect of CDSS on nursing performance and patient outcomes was inconsistent. Conclusion: The introduction of CDSS may not necessarily lead to a positive outcome; further studies are needed in order to identify contexts in which CDSS use by nurses is most effective. CDSS are complex interventions and should be evaluated as such; future studies should explore the impact of the users and the protocol on which the CDSS is based, reporting details of both. Contamination is a significant issue when evaluating CDSS, so it is important that randomization is at the practitioner or the unit level. Future systematic reviews should focus on particular uses of CDSS.

[1]  Catherine Pope,et al.  What is the role of walk-in centres in the NHS? , 2002, BMJ : British Medical Journal.

[2]  M. Leaning,et al.  Comparison of oral anticoagulant control by a nurse-practitioner using a computer decision-support system with that by clinicians. , 1997, Clinical and laboratory haematology.

[3]  Daphne Russell,et al.  Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs , 2002, BMJ : British Medical Journal.

[4]  J. Grimshaw,et al.  Effectiveness and efficiency of guideline dissemination and implementation strategies , 2005, International Journal of Technology Assessment in Health Care.

[5]  David Parkin,et al.  Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial , 2002, BMJ : British Medical Journal.

[6]  D. Richards,et al.  NHS Direct versus general practice based triage for same day appointments in primary care: cluster randomised controlled trial , 2004, BMJ : British Medical Journal.

[7]  M. Montalto,et al.  Impact of standalone and embedded telephone triage systems on after hours primary medical care service utilisation and mix in Australia , 2005, Australia and New Zealand health policy.

[8]  A. DiCenso,et al.  Advanced practice nursing roles: development, implementation and evaluation. , 2004, Journal of advanced nursing.

[9]  A. O’Cathain,et al.  Knowledge, technology and nursing: The case of NHS Direct , 2005 .

[10]  E. Furlong,et al.  Advanced nursing practice: policy, education and role development. , 2005, Journal of clinical nursing.

[11]  E. Balas,et al.  Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success , 2005, BMJ : British Medical Journal.

[12]  C P Bradley,et al.  Evaluation of computerized decision support for oral anticoagulation management based in primary care. , 1996, The British journal of general practice : the journal of the Royal College of General Practitioners.

[13]  F D Hobbs,et al.  Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing: a randomized, controlled trial. , 2000, Archives of internal medicine.

[14]  H. Mcdonald,et al.  Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. , 2005, JAMA.

[15]  Chris Salisbury,et al.  Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors , 2002, BMJ : British Medical Journal.

[16]  Alicia O'Cathain,et al.  IN NURSING PRACTICE Nurses ’ views of using computerized decision support software in NHS Direct , 2014 .

[17]  Emmy Rood,et al.  Use of a computerized guideline for glucose regulation in the intensive care unit improved both guide-line adherence and glucose regulation , 2005 .

[18]  Douglas G. Altman,et al.  BMC Medical Informatics and Decision Making , 2005 .

[19]  A pragmatic cluster randomised controlled trial of a Diabetes REcall And Management system: the DREAM trial , 2007, Implementation science : IS.

[20]  Joanne Turnbull,et al.  Safety and effectiveness of nurse telephone consultation in out of hours primary care: randomised controlled trial , 1998 .

[21]  A. O’Cathain,et al.  Telephone triage, expert systems and clinical expertise. , 2005, Sociology of health & illness.

[22]  Douglas K Owens,et al.  Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 2: Diabetes Care) , 2004 .

[23]  R. Haynes,et al.  Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes , 1998 .

[24]  Rebecca Rosen,et al.  Developing and supporting extended nursing roles: the challenges of NHS walk-in centres. , 2002, Journal of advanced nursing.

[25]  D. Mungall,et al.  Outpatient management of warfarin therapy: comparison of computer-predicted dosage adjustment to skilled professional care. , 1991, Therapeutic drug monitoring.