The use of computerised clinical decision support systems in emergency care : a substantive review of the literature

摘要

Objectives: This paper provides a substantive review of international literature evaluating the impact of computerised clinical decision support systems (CCDSS) on the care of emergency department (ED) patients. \udMaterial and Methods: A literature search was conducted using Medline, CINAHL, EMBASE electronic resources and grey literature. Studies were selected if they compared the use of a CCDSS with usual care in a face-to-face clinical interaction in an ED.\udResults: Of the 23 studies included approximately half demonstrated a statistically significant positive impact on aspects of clinical care with the use of CCDSSs. The remaining studies showed small improvements, mainly around documentation. However, the methodological quality of the studies was poor with few or no controls to mitigate against confounding variables. The risk of bias was high in all but six studies. \udDiscussion: The ED environment is complex and does not lend itself to robust quantitative designs such as Randomised Controlled Trials. The quality of the research in approximately 75% of the studies was poor and therefore conclusions cannot be drawn from these results. However the studies with a more robust design show evidence of the positive impact of CCDSSs on ED patient care. \udConclusion This is the first review to consider the role of CCDSSs in emergency care and expose the research in this area. The role of CCDSSs in Emergency Care may provide some solutions to the current challenges in EDs but further high quality research is needed to better understand what technological solutions can offer clinicians and patients.\ud\udOBJECTIVES\ud\udThis paper provides a description of a substantive review of published international literature evaluating the impact of computerised clinical decision support systems (CCDSS) on the care of emergency department (ED) patients. The principal aims of this review are: to identify the body of CCDSS research undertaken in EDs, the research methods used, their quality and the impact of CCDSSs on clinical care in EDs. The discussion synthesises what is known and not known about the effectiveness of CCDSSs in Emergency Care and the quality of the current evidence base.