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Assessment of a Computerized Intervention for Hospitalized Patients

Michael A. Fischer, MD, MS; Daniel H. Solomon, MD, MPH; Jonathan M. Teich, MD; Jerry Avorn, MD

Arch Intern Med. 2003;163:2585-2589.

Background  Many hospitalized patients continue to receive intravenous medications longer than necessary. Earlier conversion from the intravenous to the oral route could increase patient safety and comfort, reduce costs, and facilitate earlier discharge from the hospital without compromising clinical care. We examined the effect of a computer-based intervention to prompt physicians to switch appropriate patients from intravenous to oral medications.

Methods  This study was performed at Brigham and Women's Hospital, an academic tertiary care hospital at which all medications are ordered online. We targeted 5 medications with equal oral and intravenous bioavailability: fluconazole, levofloxacin, metronidazole, ranitidine, and amiodarone. We used the hospital's computerized order entry system to prompt physicians to convert appropriate intravenous medications to the oral route. We measured the total use of the targeted medications via each route in the 4 months before and after the implementation of the intervention. We also measured the rate at which physicians responded to the intervention when prompted.

Results  The average intravenous defined daily dose declined by 11.1% (P = .002) from the preintervention to the postintervention period, while the average oral defined daily dose increased by 3.7% (P = .002). Length of stay, case-mix index, and total drug use at the hospital increased during the study period. The average total monthly use of the intravenous preparation of all of the targeted medications declined in the 4 months after the intervention began, compared with the 4 months before. In 35.6% of 1045 orders for which a prompt was generated, the physician either made a conversion from the intravenous to the oral version or canceled the order altogether.

Conclusions  Computer-generated reminders can produce a substantial reduction in excessive use of targeted intravenous medications. As online prescribing becomes more common, this approach can be used to reduce excess use of intravenous medications, with potential benefits in patient comfort, safety, and cost.

From the Division of Pharmacoepidemiology and Pharmacoeconomics, the Departments of Medicine and Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. The authors have no relevant financial interest in this article.

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