Psychosocial determinants of physician acceptance toward an antimicrobial stewardship program and its computerized decision support system in an acute care tertiary hospital

Abstract Background Prospective review and feedback (PRF) of antibiotic prescriptions and compulsory computerized decision support system (CDSS) are 2 strategies of antimicrobial stewardship. There are limited studies investigating their combined effects. We hypothesized that the use of on-demand (voluntary) CDSS would achieve similar patient outcomes compared with automatically triggered (compulsory) CDSS whenever broad-spectrum antibiotics are ordered. Methods A parallel-group, 1:1 block cluster randomized crossover study was conducted in 32 medical and surgical wards from March to August 2017. CDSS use for piperacillin-tazobactam or carbapenem in the intervention clusters was at the demand of the doctor, while in the control clusters CDSS use was compulsory. PRF was continued for both arms. The primary outcome was 30-day mortality. Results Six hundred forty-one and 616 patients were randomized to voluntary and compulsory CDSS, respectively. There were no differences in 30-day mortality (hazard ratio [HR], 0.87; 95% CI, 0.67–1.12), re-infection and re-admission rates, antibiotic duration, length of stay, or hospitalization cost. The proportion of patients receiving PRF recommendations was not significantly lower in the voluntary CDSS arm (62 [10%] vs 81 [13%]; P = .05). Appropriate indication of antibiotics was high in both arms (351/448 [78%] vs 330/433 [74%]; P = .18). However, in geriatric medicine patients where antibiotic appropriateness was <50%, prescription via compulsory CDSS resulted in a shorter length of stay and lower hospitalization cost. Conclusions Voluntary broad-spectrum antibiotics with PRF via CDSS did not result in differing clinical outcomes, antibiotic duration, or length of stay. However, in the setting of low antibiotic appropriateness, compulsory CDSS may be beneficial.

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Impact of a 4-year antimicrobial stewardship program implemented in a Greek tertiary hospital

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-021-04290-7 ◽

2021 ◽

Author(s):

Konstantina Chrysou ◽

Olympia Zarkotou ◽

Sofia Kalofolia ◽

Panagiota Papagiannakopoulou ◽

Vasiliki Mamali ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Tertiary Hospital ◽

Antimicrobial Stewardship Program ◽

Stewardship Program

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Redesign of computerized decision support system to improve Non Vitamin K oral anticoagulant prescribing- A pre and post qualitative and quantitative study

International Journal of Medical Informatics ◽

10.1016/j.ijmedinf.2021.104511 ◽

2021 ◽

pp. 104511

Author(s):

Viviane Khalil

Keyword(s):

Decision Support ◽

Decision Support System ◽

Quantitative Study ◽

Vitamin K ◽

Support System ◽

Oral Anticoagulant ◽

Computerized Decision Support ◽

Qualitative And Quantitative ◽

Qualitative And Quantitative Study

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Penerapan Metode Rank Order Centroid dan Additive Ratio Assessment Pada Aplikasi Rekomendasi Supplier

EDUMATIC Jurnal Pendidikan Informatika ◽

10.29408/edumatic.v5i1.3252 ◽

2021 ◽

Vol 5 (1) ◽

pp. 31-40

Author(s):

Ronny Addenan ◽

◽

Wilda Susanti ◽

Keyword(s):

Decision Support ◽

Decision Support System ◽

Support System ◽

Selection Process ◽

Rank Order ◽

Spare Parts ◽

Computerized Decision Support ◽

K Value ◽

Long Time ◽

The Right

PT.Yanmarindo Perkasa is a company in the sale of diesel engines, generators, tooling tools and engine spare parts. Many suppliers want to distribute their goods through PT.Yanmarindo Perkasa, thus demanding the company to choose the right supplier, in order to ensure the smooth fulfillment of stock items. The process of selecting suppliers is still done manually with criteria limited to quantitative criteria, so that the process takes a long time and the results are not precise. The purpose of this study is to build a decision support system for supplier recommendations quickly and precisely in meeting the company's needs. The supplier selection process uses the Rank-Order Centroid (ROC) method in weighting the criteria and the Additive Ratio Assessment (ARAS) for ranking. ARAS value obtained is the K value that is ranked to get the best supplier by using a computerized decision support system. The application of these two methods can speed up the results of decisions, does not take a long time and the results obtained are also maximum.

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Clinical impact of accepting or rejecting a recommendation from a clinical decision support system–assisted antibiotic stewardship program

Official Journal of the Association of Medical Microbiology and Infectious Disease Canada ◽

10.3138/jammi-2020-0036 ◽

2021 ◽

pp. e20200036

Author(s):

Esther Nadeau ◽

Adam Mercier ◽

Julie Perron ◽

Mélanie Gilbert ◽

Vincent Nault ◽

...

Keyword(s):

Decision Support ◽

Decision Support System ◽

Clinical Decision Support ◽

Support System ◽

Clinical Decision Support System ◽

Clinical Decision ◽

Antimicrobial Treatment ◽

Charlson Comorbidity Index Score ◽

Individual Patient Level ◽

Stewardship Program

Background: Outcomes associated with physician responses to recommendations from an antimicrobial stewardship program (ASP) at an individual patient level have not yet been assessed. We aimed to compare clinical characteristics and mortality risk among patients for whom recommendations from an ASP were accepted or refused. Methods: A prospective cohort study was performed with hospitalized adults who received intravenous or oral antimicrobials at a 677-bed academic centre in Canada in 2014–2017. We included patients with an alert produced by a clinical decision support system (CDSS) for whom a recommendation was made by the pharmacist to the attending physician. The outcome was 90-day in-hospital all-cause mortality. Results: We identified 3,197 recommendations throughout the study period, of which 2,885 (90.2%) were accepted. The median length of antimicrobial treatment was significantly shorter when a recommendation was accepted (0.26 versus 1.78 days; p < 0.001). Refusal of a recommendation was not associated with mortality (odds ratio 1.32; 95% confidence interval, 0.93 to 1.89; p = 0.12). The independent risk factors associated with in-hospital mortality were age, Charlson Comorbidity Index score, admission to a critical care unit, duration between admission and recommendation, and issuance of a recommendation on a carbapenem. Conclusions: The duration of antimicrobial treatment was significantly shorter when a recommendation originating from a CDSS-assisted ASP program was accepted. Future prospective studies including potential residual confounding variables, such as the source of infection or physiological derangement, might help in understanding whether CDSS-assisted ASP will have a direct impact on patient mortality.

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