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Effect of Computer-Based Alerts on the Treatment and Outcomes of Hospitalized Patients

Effect of Computer-Based Alerts on the Treatment and Outcomes of Hospitalized Patients Abstract Background: Hospital computing systems play an important part in the communication of clinical information to physicians. We sought to determine whether computer-based alerts for hospitalized patients can affect physicians' behavior and improve patients' outcomes. Methods: We performed a prospective time-series study to determine whether computerized alerts to physicians about rising creatinine levels in hospitalized patients receiving nephrotoxic or renally excreted medications led to more rapid adjustment or discontinuation of those medications, and to determine whether such alerts protected renal function. Results: Laboratory data were observed for 20 228 hospitalizations, with documentation of 1573 events (instances of rising creatinine levels during treatment with a nephrotoxic or renally excreted drug). During the intervention period, doses were adjusted or medications discontinued an average of 21.6 hours sooner after such an event (P<.0001). For patients receiving nephrotoxic medications during the intervention period, the relative risk of serious renal impairment was 0.45 (95% confidence interval, 0.22 to 0.94) as compared with the control period, and the mean serum creatinine level was 14.1 μmol/L (0.16 mg/dL) lower on day 3 (P<.01) and 25.6 μmol/L (0.29 mg/dL) lower on day 7 (P<.05) after an event. Forty-four percent of physicians who responded to a questionnaire said that the alerts had been helpful in the care of their patients, whereas 28% found them annoying. Sixty-five percent wished to continue receiving alerts. Conclusions: Computer-based alerts regarding patients with rising creatinine levels affect physician behavior, prevent serious renal impairment, preserve renal function, and are accepted by clinicians.(Arch Intern Med. 1994;154:1511-1517) References 1. Bedell SE, Deitz DC, Leeman D, Delbanco TL. Incidence and characteristics of preventable iatrogenic cardiac arrests . JAMA . 1991;265:2815-2820.Crossref 2. Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP system . J Med Syst. 1983;7:87-102.Crossref 3. Stead WW, Hammond WE. Computerized medical records: a new resource for clinical decision making . J Med Syst. 1983;7:213-220.Crossref 4. Scherrer JR. The integrated real-time hospital information system : DIOGENE. World Hosp. 1983;19( (4) ):8-11. 5. Bakker AR. The development of an integrated and co-operative hospital information system . Med Inf. 1984;9:135-142.Crossref 6. Barnett GO. The application of computer-based medical record systems in ambulatory practice . N Engl J Med. 1984;310:1643-1650.Crossref 7. Whiting-O'Keefe QE, Whiting A, Henke J. The STOR clinical information system . MD Comput. 1988;5:8-21. 8. Hendrickson G, Anderson RK, Clayton PD, et al. The integrated academic information management system at Columbia-Presbyterian Medical Center . MD Comput. 1992;9:35-42. 9. Weed LL. Medical records that guide and teach . N Engl J Med. 1968;278:593-600.Crossref 10. Bleich HL, Beckley RF, Horowitz GL, et al. Clinical computing in a teaching hospital . N Engl J Med. 1985;312:756-764.Crossref 11. McDonald CJ, Hui SL, Smith DM, et al. Reminders to physicians from an introspective computer medical record: a two-year randomized trial . Ann Intern Med. 1984;100:130-138.Crossref 12. Fordham D, McPhee SJ, Bird JA, Rodnick JE, Detmer WM. The Cancer Prevention Reminder System . MD Comput. 1990;7:289-295. 13. Ornstein SM, Garr DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders: tools to improve population adherence to selected preventive services . J Fam Pract. 1991;32:82-90. 14. Frame PS. Can computerized reminder systems have an impact on preventive services in practice? J Gen Intern Med. 1990;5( (suppl 5) ):S112-S115.Crossref 15. Tierney WM, McDonald CJ, Martin DK, Hui SL, Rogers MP. Computerized display of past test results: effect on outpatient testing . Ann Intern Med. 1987; 107:569-574.Crossref 16. McDonald CJ. Protocol-based computer reminders, the quality of care and the non-perfectibility of man . N Engl J Med. 1976;295:1351-1355.Crossref 17. McDonald CJ, Wilson GA, McCabe GP. Physician response to computer reminders . JAMA . 1980;244:1579-1581.Crossref 18. Safran C, Bleich HL, Slack WV. Role of computing in patient care in two hospitals . MD Comput. 1989;6:141-148. 19. Bleich HL, Safran C, Slack WV. Departmental and laboratory computing in two hospitals . MD Comput. 1989;6:149-155. 20. Safran C, Porter D, Lightfoot J, et al. Clin-Query: a system for online searching of data in a teaching hospital . Ann Intern Med. 1989;111:751-756.Crossref 21. Bonney SL, Northington RS, Hedrich DA, Walker BR. Renal safety of two analgesics used over the counter: ibuprofen and aspirin . Clin Pharmacol Ther. 1986;40:373-377.Crossref 22. Murray MD, Brater DC, Tierney WM, Hui SL, McDonald CJ. Ibuprofen-associated renal impairment in a large general internal medicine practice . Am J Med Sci. 1990;299:222-229.Crossref 23. Bloom SM, White RJ, Beckley RF, Slack WV. Converse: a means to write, edit, administer, and summarize computer-based dialogue . Comput Biomed Res. 1978;11:167-175.Crossref 24. Hennekens CH, Buring JE. Epidemiology in Medicine . Boston, Mass: Little Brown & Co; 1987. 25. Whelton A, Stout RL, Spilman PS, Klassen DK. Renal effects of ibuprofen, piroxicam, and sulindac in patients with asymptomatic renal failure . Ann Intern Med. 1990;112:568-576.Crossref 26. McDonald CJ, Hui SL, Tierney WM. Effects of computer reminders for influenza vaccination on morbidity during influenza epidemics . MD Comput. 1992; 9:304-312. 27. Morrell J, Podlone M, Cohen SN. Receptivity of physicians in a teaching hospital to a computerized drug interaction monitoring and reporting system . Med Care. 1977;15:68-78.Crossref 28. Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients . JAMA . 1991;266:2847-2851.Crossref 29. Tate KE, Gardner RE, Weaver LK. A computerized laboratory alerting system . MD Comput. 1990;7:296-301. 30. Safran C, Herrmann F, Rind D, Kowaloff BA, Bleich HL, Slack WV. Computer-based support for clinical decision making . MD Comput. 1990;7:319-322. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Effect of Computer-Based Alerts on the Treatment and Outcomes of Hospitalized Patients

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420130107014
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Hospital computing systems play an important part in the communication of clinical information to physicians. We sought to determine whether computer-based alerts for hospitalized patients can affect physicians' behavior and improve patients' outcomes. Methods: We performed a prospective time-series study to determine whether computerized alerts to physicians about rising creatinine levels in hospitalized patients receiving nephrotoxic or renally excreted medications led to more rapid adjustment or discontinuation of those medications, and to determine whether such alerts protected renal function. Results: Laboratory data were observed for 20 228 hospitalizations, with documentation of 1573 events (instances of rising creatinine levels during treatment with a nephrotoxic or renally excreted drug). During the intervention period, doses were adjusted or medications discontinued an average of 21.6 hours sooner after such an event (P<.0001). For patients receiving nephrotoxic medications during the intervention period, the relative risk of serious renal impairment was 0.45 (95% confidence interval, 0.22 to 0.94) as compared with the control period, and the mean serum creatinine level was 14.1 μmol/L (0.16 mg/dL) lower on day 3 (P<.01) and 25.6 μmol/L (0.29 mg/dL) lower on day 7 (P<.05) after an event. Forty-four percent of physicians who responded to a questionnaire said that the alerts had been helpful in the care of their patients, whereas 28% found them annoying. Sixty-five percent wished to continue receiving alerts. Conclusions: Computer-based alerts regarding patients with rising creatinine levels affect physician behavior, prevent serious renal impairment, preserve renal function, and are accepted by clinicians.(Arch Intern Med. 1994;154:1511-1517) References 1. Bedell SE, Deitz DC, Leeman D, Delbanco TL. Incidence and characteristics of preventable iatrogenic cardiac arrests . JAMA . 1991;265:2815-2820.Crossref 2. Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP system . J Med Syst. 1983;7:87-102.Crossref 3. Stead WW, Hammond WE. Computerized medical records: a new resource for clinical decision making . J Med Syst. 1983;7:213-220.Crossref 4. Scherrer JR. The integrated real-time hospital information system : DIOGENE. World Hosp. 1983;19( (4) ):8-11. 5. Bakker AR. The development of an integrated and co-operative hospital information system . Med Inf. 1984;9:135-142.Crossref 6. Barnett GO. The application of computer-based medical record systems in ambulatory practice . N Engl J Med. 1984;310:1643-1650.Crossref 7. Whiting-O'Keefe QE, Whiting A, Henke J. The STOR clinical information system . MD Comput. 1988;5:8-21. 8. Hendrickson G, Anderson RK, Clayton PD, et al. The integrated academic information management system at Columbia-Presbyterian Medical Center . MD Comput. 1992;9:35-42. 9. Weed LL. Medical records that guide and teach . N Engl J Med. 1968;278:593-600.Crossref 10. Bleich HL, Beckley RF, Horowitz GL, et al. Clinical computing in a teaching hospital . N Engl J Med. 1985;312:756-764.Crossref 11. McDonald CJ, Hui SL, Smith DM, et al. Reminders to physicians from an introspective computer medical record: a two-year randomized trial . Ann Intern Med. 1984;100:130-138.Crossref 12. Fordham D, McPhee SJ, Bird JA, Rodnick JE, Detmer WM. The Cancer Prevention Reminder System . MD Comput. 1990;7:289-295. 13. Ornstein SM, Garr DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders: tools to improve population adherence to selected preventive services . J Fam Pract. 1991;32:82-90. 14. Frame PS. Can computerized reminder systems have an impact on preventive services in practice? J Gen Intern Med. 1990;5( (suppl 5) ):S112-S115.Crossref 15. Tierney WM, McDonald CJ, Martin DK, Hui SL, Rogers MP. Computerized display of past test results: effect on outpatient testing . Ann Intern Med. 1987; 107:569-574.Crossref 16. McDonald CJ. Protocol-based computer reminders, the quality of care and the non-perfectibility of man . N Engl J Med. 1976;295:1351-1355.Crossref 17. McDonald CJ, Wilson GA, McCabe GP. Physician response to computer reminders . JAMA . 1980;244:1579-1581.Crossref 18. Safran C, Bleich HL, Slack WV. Role of computing in patient care in two hospitals . MD Comput. 1989;6:141-148. 19. Bleich HL, Safran C, Slack WV. Departmental and laboratory computing in two hospitals . MD Comput. 1989;6:149-155. 20. Safran C, Porter D, Lightfoot J, et al. Clin-Query: a system for online searching of data in a teaching hospital . Ann Intern Med. 1989;111:751-756.Crossref 21. Bonney SL, Northington RS, Hedrich DA, Walker BR. Renal safety of two analgesics used over the counter: ibuprofen and aspirin . Clin Pharmacol Ther. 1986;40:373-377.Crossref 22. Murray MD, Brater DC, Tierney WM, Hui SL, McDonald CJ. Ibuprofen-associated renal impairment in a large general internal medicine practice . Am J Med Sci. 1990;299:222-229.Crossref 23. Bloom SM, White RJ, Beckley RF, Slack WV. Converse: a means to write, edit, administer, and summarize computer-based dialogue . Comput Biomed Res. 1978;11:167-175.Crossref 24. Hennekens CH, Buring JE. Epidemiology in Medicine . Boston, Mass: Little Brown & Co; 1987. 25. Whelton A, Stout RL, Spilman PS, Klassen DK. Renal effects of ibuprofen, piroxicam, and sulindac in patients with asymptomatic renal failure . Ann Intern Med. 1990;112:568-576.Crossref 26. McDonald CJ, Hui SL, Tierney WM. Effects of computer reminders for influenza vaccination on morbidity during influenza epidemics . MD Comput. 1992; 9:304-312. 27. Morrell J, Podlone M, Cohen SN. Receptivity of physicians in a teaching hospital to a computerized drug interaction monitoring and reporting system . Med Care. 1977;15:68-78.Crossref 28. Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients . JAMA . 1991;266:2847-2851.Crossref 29. Tate KE, Gardner RE, Weaver LK. A computerized laboratory alerting system . MD Comput. 1990;7:296-301. 30. Safran C, Herrmann F, Rind D, Kowaloff BA, Bleich HL, Slack WV. Computer-based support for clinical decision making . MD Comput. 1990;7:319-322.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 11, 1994

References