Clinical Decision Support Systems in Hospitalized Older Patients: An Exploratory Analysis in a Real-Life Clinical Setting

• Published in: Drugs - Real World Outcomes 2023-09, Vol.10 (3), p.363-370
• Main Authors: Linkens, Aimée E. M. J. H., Kurstjens, Dennis, Zwietering, N. Anne, Milosevic, Vanja, Hurkens, Kim P. G. M., van Nie, Noémi, van de Loo, Bob P. A., van der Kuy, P. Hugo M., Spaetgens, Bart
• Format: Article
• Language: English
• Subjects: Aged patients; Antibiotics; Anticoagulants; Clinical decision making; Clinical trials; Decision support systems; Drug therapy; Health aspects; Hospital patients; Hospitalization; Internal Medicine; Intervention; Laboratories; Laxatives; Medicine; Medicine & Public Health; Mortality; Narcotics; Older people; Original; Original Research Article; Patient admissions; Pharmacology/Toxicology; Pharmacotherapy; Potassium
• ISSN: 2199-1154; 2198-9788
• DOI: 10.1007/s40801-023-00365-3

Background Inappropriate prescribing is associated with negative patient outcomes. In hospitalized patients, the use of Clinical Decision Support Systems (CDSSs) may reduce inappropriate prescribing and thereby improve patient-related outcomes. However, recently published large clinical trials (OPERAM and SENATOR) have shown negative results on the use of CDSSs and patient outcomes and strikingly low acceptance of recommendations. Objective The purpose of the present study was to investigate the use of a CDSS in a real-life clinical setting of hospitalized older patients. As such, we report on the real-life pattern of this in-hospital implemented CDSS, including (i) whether generated alerts were resolved; (ii) whether a recorded action by the pharmacist led to an improved number of resolved alerts; and (iii) the natural course of generated alerts, in particular of those in the non-intervention group; as these data are largely lacking in current studies. Methods Hospitalized patients, aged 60 years and older, admitted to Zuyderland Medical Centre, the Netherlands, in 2018 were included. The evaluation of the CDSS was investigated using a database used for standard care. Alongside demographic and clinical data, we also collected the total numbers of CDSS alerts, the number of alerts ‘handled’ by the pharmacist, those that resulted in an action by the pharmacist, and finally the outcome of the alerts at day 1 and day 3 after the alert was generated. Results A total of 3574 unique hospitalized patients, mean age 76.7 (SD 8.3) years and 53% female, were included. From these patients, 8073 alerts were generated, of which 7907 (97.9% of total) were handled by the pharmacist (day 1). In 51.6% of the alerts handled by the pharmacist, an action was initiated, resulting in 36.1% of the alerts resolved after day 1, compared with 27.3% if the pharmacist did not perform an action ( p