Decision support systems may improve quality

Studies show beneficial effect on docs’ performance

Computerized clinical decision support systems, which match patient-specific characteristics to clinical information databases, can reduce hospital errors and cut costs, according to three recent studies. Dereck L. Hunt, MD, and colleagues at McMaster University in Hamilton, Ontario, Canada, reviewed 68 trials that evaluated various systems between 1974 and 1998. About two-thirds of the trials showed that the systems had a beneficial effect on physician performance.1 The trials included studies on drug dosing, diagnostic aids, and preventive care.

David W. Bates, MD, of Brigham and Women’s Hospital in Boston, and colleagues evaluated a system designed to monitor the ordering, administration, and dispensing stages of drug administration at a large community hospital.2 The researchers compared the number of nonintercepted serious medication errors made during the six months before the system was introduced with those made during the nine months following its introduction. The number of medication errors dropped 55% after the system was introduced. By preventing drug administration mistakes, the system could save between $5 million and $10 million annually, the investigators estimate. The decision support system there cost $1.9 million to install and costs $500,000 per year to operate.

System projected to save $3 million annually

Robert A. Raschke, MD, of Good Samaritan Regional Medical Center in Phoenix, evaluated a smaller, less sophisticated program that alerts physicians to clinical situations with increased risk for adverse drug event-related injury and concluded the program can prevent hospital errors and save money.3 During a six-month trial period at a 650-bed teaching hospital, the system alerted physicians to nearly 600 potential errors, according to the researchers. Because the average preventable adverse drug event adds nearly $6,000 to the cost of hospitalization, as much as $3 million might be saved annually, write the investigators.

The investigators caution that, given variations in the quality of decision support systems and the rapid pace of technological improvement, hospitals should evaluate different systems carefully before adopting them.

References

1. Bates DW, Leape LL, Cullen DJ. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280:1,311-1,320.

2. Raschke RA, Gollihare B, Wunderlich TA. A computer alert system to prevent injury from adverse drug events: Development and evaluation in a community teaching hospital. JAMA 1998; 280:1,339-1,345.

3. Hunt DL, Haynes RB, Hanna SE. Effects of computer-based clinical decision support systems on physician performance and patient outcomes. JAMA 1998; 280:1,360-1,361.