Table 1 Results for CCDSS trials of acute care
Study | Methods Score | Indication | No. of centres/providers/patients | Process of care outcomes | CCDSS Effecta | Patient outcomes | CCDSS Effect a |
|---|---|---|---|---|---|---|---|
Management Assistants - Alerts and Reminders | |||||||
Terrell, 2009 [48] | 9 | CCDSS provided alerts to avoid inappropriate prescriptions in geriatric outpatients during discharge from emergency care. | 1/63*/5,162' | ED visits by older adults that resulted in prescriptions for ≥1 of nine targeted inappropriate medications. | + | ... | ... |
Peterson, 2007 [36]b | 4 | CCDSS provided dosing advice for high-risk drugs in geriatric patients in a tertiary care academic health centre. | 1/778/2,981* | Ratio of prescribed to recommended doses. | + | ... | ... |
Kroth, 2006 [39] | 7 | CCDSS identified low temperature values and generated prompts to repeat measurement in order to improve accuracy of temperature capture by nurses at the bedside of non-critical care hospital patients. | .../337*/90,162 | Low temperatures recorded by nursing personnel type. | + | ... | ... |
Rood, 2005 [34] | 8 | CCDSS recommended timing for glucose measurements and administration of insulin in critically ill patients. | 1/104/484* | Deviation between advised and actual glucose measurement times; Time that patients' glucose levels were within specified range over 10 weeks; Adherence to guideline for timing of glucose measurement. | + | ... | ... |
Zanetti, 2003 [47] | 8 | CCDSS provided alarm and alert for redosing of prophylactic antibiotics during prolonged cardiac surgery. | 1/.../447* | Intraoperative redose of antibiotics. | + | Surgical-site infection. | 0 |
Selker, 2002 [29] | 8 | CCDSS generated recommendations for management of thrombolytic and other reperfusion therapy in acute myocardial infarction. | 28/.../1,596* | Detection of ST-segment elevation without AMI; Receipt of thrombolytic therapy; Receipt of thrombolytic therapy and contraindications; Treatment of patients with AMI. | 0 | Mortality; Stroke; Thrombolysis-related bleeding events requiring transfusion. | 0 |
Dexter, 2001 [19] | 10 | CCDSS provided guideline-based reminders for preventive therapies in hospital inpatients. | ...*/202/3,416 | Hospitalizations with an order for therapy; Hospitalizations during which therapy was ordered for an eligible patient. | + | ... | ... |
Kuperman, 1999 [23] | 4 | CCDSS detected critical laboratory results for all medical and surgical inpatients and alerted health provider that the results were ready. | 1/.../...* | Length of time interval from filing alerting result to ordering of appropriate treatment; Filing time and resolution of critical condition. | + | Adverse events within 48 hours of alert. | 0 |
Overhage, 1997 [26] | 8 | CCDSS identified corollary orders to prevent errors of omission for any of 87 target tests and treatments in hospital inpatients on a general medicine ward. | 1*/92/2,181 | Compliance with corollary orders; Pharmacist intervention with physicians for significant errors. | + | LOHS; Serum creatinine level. | 0 |
Overhage, 1996 [25] | 10 | CCDSS provided reminders of 22 US Preventive Services Task Force preventive care measures for hospital inpatients, including cancer screening, preventive screening and medications, diabetes care reminders, and vaccinations. | 1*/78/1,622 | Compliance with preventive care guidelines. | 0 | ... | ... |
White, 1984 [31] | 4 | CCDSS identified concerns (drug interactions or signs of potential digoxin intoxication) in inpatients taking digoxin. | 1/.../396* | Physician actions related to alerts. | + | ... | ... |
Management Assistants - Guidelines and algorithms | |||||||
Helder, 2008 [43] | 6 | CCDSS generated recommendations for management of incubator settings in neonatal ICU. | 1/117/136* | Days to regain birthweight. | 0 | Intraventricular haemorrhage; Sepsis; Mortality. | 0 |
Davis, 2007 [42] | 9 | CCDSS provided evidence-based data relating to appropriate prescribing for upper respiratory tract infections in paediatric outpatients. | 2/44*/12,195 | Prescriptions consistent with evidence-based recommendations. | + | ... | ... |
7 | CCDSS generated recommendations for non-emergent inpatient transfusion orders. | 1/1,414*/3,903 | Appropriateness ratings of decision support interventions. | + | Severely undertransfused patients. | 0 | |
Kuilboer, 2006 [41] | 10 | CCDSS assisted monitoring and treatment of asthma and COPD in daily practice in primary care. | 32*/40/156,772 | Contacts; Peak total flow; Peak flow ratio; FEV1; FEV1 ratio measurements; Antihistamines prescriptions; Cromoglycate prescriptions; Deptropine prescriptions; Oral bronchodilators prescriptions; Oral corticosteroids prescriptions. | 0 | ... | ... |
Paul, 2006 [40] | 10 | CCDSS assisted management of antibiotic treatment in hospital inpatients. | 15*/.../2,326 | Appropriate antibiotic treatment. | + | Duration of hospital; Duration of fever; Mortality. | 0 |
Brothers, 2004 [46] | 6 | CCDSS provided recommendations for surgical management of patients with peripheral arterial disease. | 2/3/206* | Agreement between surgeon's initial and final treatment plan. | 0 | ... | ... |
Hamilton, 2004 [44] | 8 | CCDSS provided evaluation and recommendations of labour progress and need for caesarean sections. | 7/.../4,993* | Caesarean sections. | 0 | Recorded indication of dystocia; Apgar score. | 0 |
Hales, 1995 [20] | 4 | CCDSS evaluated appropriateness of inpatient admissions. | 1/.../1,971* | Unnecessary hospital admissions. | 0 | ... | ... |
Wyatt, 1989 [33] | 5 | CCDSS generated recommendations resulting in identification of high-cardiac risk patients among patients with chest pain attending the ED. | 1/15/153* | Overall management accuracy; Time until cardiac care unit admission. | ... | ... | ... |
Diagnostic Assistants | |||||||
Roukema, 2008 [35] | 6 | CCDSS provided advice for the diagnostic management for children with fever without apparent source in the ED. | 1/15/164* | Test ordering. | + | Time spent at ED. | 0 |
Stengel, 2004 [45] | 8 | CCDSS assisted electronic documentation of diagnosis and findings in patients admitted to orthopaedic ward. | 1/6/78* | Diagnoses per patient. | + | ... | ... |
Bogusevicius2002 [15] | 7 | CCDSS generated diagnosis of acute SBO in surgical inpatients. | 1/.../80 | Diagnosis of acute SBO; Diagnosis of partial SBO; Time to diagnosis. | 0 | Bowel necrosis; Morbidity; Mortality; LOHS; Proportion of patients receiving each type of surgical procedure: open lysis of adhesion; laparoscopic lysis of adhesion; bowel resection. | 0 |
Medication Dosing Assistants | |||||||
Cavalcanti, 2009 [49] | 8 | CCDSS recommended insulin dosing and glucose monitoring to achieve glucose control in patients in ICU. | 5/60/168* | BG measurements obtained per patient; Time with BG controlled. | + | BG during ICU stay; Hypoglycaemia. | +/0 |
Saager, 2008 [50] | 6 | CCDSS recommended insulin dosing and glucose assessment frequency for diabetic patients in cardiothoracic ICU. | 1/.../40* | BG in range (90 to 150 mg/dL); Time in range. | + | Mean BG; Mean time to BG<150 mg/dL. | + |
Peterson, 2007 [36]b | 4 | CCDSS provided dosing advice for high-risk drugs in geriatric patients in a tertiary care academic health centre. | 1/778/2,981* | Ratio of prescribed to recommended doses. | + | ... | ... |
Poller, 1998 [28] | 3 | CCDSS provided dosing for oral anticoagulants in outpatients with AF, DVT or PE, mechanical heart valves, or other indications. | 5/.../285* | Time within target INR range for all patients and all ranges; Proportion of time in target range. | + | ... | ... |
Vadher, 1997 [30] | 6 | CCDSS provided dosing recommendations for warfarin initiation and maintenance for inpatients and outpatients with DVT, PE or systemic embolus, AF, valve disease, or mural thrombus, or who needed prophylaxis. | 1/49/148* | Time to reach therapeutic range; Time to reach stable dose; Time to first pseudoevent; Days at INR 2 to 3. | 0 | Mortality; Haemorrhage events; Thromboembolism events. | ... |
Casner, 1993 [18] | 3 | CCDSS predicted theophylline infusion rates for inpatients with asthma or COPD. | 1/.../47* | Serum theophylline levels; Absolute difference between final and target theophylline levels; Mean difference between target and mean final theophylline level; Subtherapeutic final theophylline levels; Toxic final theophylline levels. | 0 | Theophylline-associated toxicity; LOHS; Duration of treatment. | 0 |
Burton, 1991 [16] | 6 | CCDSS provided aminoglycoside dosing for inpatients with clinical infections. | 1*/.../147 | Beginning aminoglycoside dose; Ending aminoglycoside dose; Ending aminoglycoside dose interval; Peak aminoglycoside level; Peak aminoglycoside level >4 mg/L; Trough aminoglycoside levels; Proportion of patients with trough aminoglycoside levels ≥2 mg/L; Length of aminoglycoside therapy. | 0 | Proportion of patients cured; Response to therapy; Treatment failure; Mortality; Indeterminate response; Nephrotoxicity; LOHS; LOHS after start of antibiotics. | 0 |
Begg, 1989 [14] | 4 | CCDSS provided individualised aminoglycoside dosing for inpatients receiving gentamicin or tobramycin. | .../.../50* | Achievement of peak and trough aminoglycoside levels. | + | Mortality; Creatinine clearance during therapy. | 0 |
Gonzalez, 1989 [22] | 5 | CCDSS estimated aminophylline loading and maintenance dosing for ED patients. | .../.../67* | Aminophylline loading dose to achieve target serum theophylline level; Aminophylline maintenance dose to achieve target serum theophylline level; Theophylline level. | + | Discharged from ED within 8 hours; Adverse effects; Peak flow rate throughout the study. | 0 |
Hickling, 1989 [21] | 3 | CCDSS provided dosing and dose intervals of aminoglycoside in critically ill patients. | 1/.../32* | Proportion of patients outside of therapeutic range; Peak plasma aminoglycoside levels; Trough levels; Proportion of patients with 48-72 h peak plasma levels. | + | Estimated creatinine clearance during recovery. | 0 |
Carter, 1987 [17] | 2 | CCDSS provided dosing recommendations for warfarin initiation and adjustments in hospital inpatients. | 1/.../54* | Days from administration of first warfarin dose to achievement of stabilization dosage. | 0 | Time to discharge. | ... |
White, 1987 [32] | 6 | CCDSS provided dosing recommendations for warfarin therapy in patients hospitalized with DVT, cerebrovascular accident, transient ischemic attack, PE or AF. | 2/.../75* | Time to reach a stable therapeutic dose; Time to reach a therapeutic PR ratio; Patients with PR above therapeutic range during hospital stay; Predicted/observed PR; Absolute error. | + | LOHS; In-hospital bleeding complications. | + |
Hurley, 1986 [24] | 8 | CCDSS provided dosing for theophylline in inpatients with acute air-flow obstruction. | 1/.../96* | Theophylline levels above therapeutic range; Theophylline levels below therapeutic range; Trough theophylline levels in therapeutic range during oral therapy; Serum theophylline levels; 1st serum level during oral therapy; Trough levels during oral therapy. | 0 | Peak expiratory flow rate; Air flow obstruction symptoms; Side effects; Mortality. | 0 |
Rodman, 1984 [27] | 6 | CCDSS recommended lidocaine dosing for patients in intensive or coronary care units. | 1/.../20* | Plasma lidocaine levels in middle of therapeutic range. | + | Toxic response requiring lidocaine discontinuation or dosage reduction. | 0 |