Leveraging electronic medical records to evaluate a computerized decision support system for staphylococcus bacteremia

npj Digital Medicine, vol. 8, pp. 180

Abstract

Infectious disease specialists (IDS) improve outcomes of patients with Staphylococcus bacteremia, but immediate IDS access is not always guaranteed. We investigated whether a care-integrated computerized decision support system (CDSS) can safely enhance the standard of care (SOC) for these patients. We conducted a multicenter, noninferiority, interventional stepped-wedge cluster randomized controlled trial relying on the data integration centers at five university hospitals. By this means, electronic medical records can be used for part of the trial documentation. We analyzed 5056 patients from 134 wards (Staphylococcus aureus (SAB): n = 812, coagulase-negative staphylococci (CoNS): n = 4244) and found that the CDSS was noninferior to the SOC for hospital mortality in all patients. Noninferiority regarding the 90-day mortality/relapse in SAB patients was not observed and there was no evidence for differences in vancomycin usage among CoNS patients. Despite low reported usage, physicians rated the CDSS's usability favorably. Trial registration: drks.de; Identifier: DRKS00014320; Registration Date: 2019-05-06.

Authors 43

1. Julia Palm corresponding

   Jena University Hospital

   Affiliation as printed

   Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany. julia.palm@med.uni-jena.de

2. Ssuhir Alaid

   University Hospital in Halle

   Affiliation as printed

   IT Department, Data Integration Center, University Hospital Halle, Halle, Germany

3. Danny Ammon

   Jena University Hospital

   Affiliation as printed

   Data Integration Center, Jena University Hospital, Jena, Germany

4. Julian Brandes

   Leipzig University

   Affiliation as printed

   Center for Medical Informatics, Data Integration Center, University of Leipzig Medical Center, Leipzig, Germany

5. Andreas Dürschmid

   Leipzig University

   Affiliation as printed

   Center for Medical Informatics, Data Integration Center, University of Leipzig Medical Center, Leipzig, Germany

6. Claudia Fischer

   Jena University Hospital

   Affiliation as printed

   Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany

7. Jonas Fortmann Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany

8. Kristin Friebel

   Jena University Hospital

   Affiliation as printed

   Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany

9. Sarah Geihs Aachen IT Department Data Integration Center

   Universitätsklinikum Aachen

   Affiliation as printed

   IT Department, Data Integration Center, University Hospital Aachen, Aachen, Germany

10. Anne-Kathrin Hartig

    University Hospital in Halle

    Affiliation as printed

    IT Department, Data Integration Center, University Hospital Halle, Halle, Germany

11. Andrew J Heidel

    Jena University Hospital

    Affiliation as printed

    Data Integration Center, Jena University Hospital, Jena, Germany

12. Petra Hetfeld Aachen Department of Intensive Care Medicine and Intermediate Care

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany

13. Roland Ihle

    Essen University Hospital

    Affiliation as printed

    Central IT Department, Data Integration Center, University Hospital Essen, Essen, Germany

14. Verena Koi

    Leipzig University

    Affiliation as printed

    Center for Medical Informatics, Data Integration Center, University of Leipzig Medical Center, Leipzig, Germany

15. Margarethe Konik

    Essen University Hospital · University of Duisburg-Essen

    Affiliation as printed

    Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany

16. Frauke Kretzschmann Aachen IT Department Data Integration Center

    Universitätsklinikum Aachen

    Affiliation as printed

    IT Department, Data Integration Center, University Hospital Aachen, Aachen, Germany

17. Henner Kruse

    Jena University Hospital

    Affiliation as printed

    Data Integration Center, Jena University Hospital, Jena, Germany

18. Norman Lippmann

    University Hospital Leipzig

    Affiliation as printed

    Institute for Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany

19. Christoph Lübbert

    University Hospital Leipzig · Leipzig University

    Affiliation as printed

    Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, University Hospital Leipzig, Leipzig, Germany

20. Gernot Marx Aachen Department of Intensive Care Medicine and Intermediate Care

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Intensive Care Medicine and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany

21. Rafael Mikolajczyk

    Martin Luther University Halle-Wittenberg

    Affiliation as printed

    Institute of Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin-Luther University Halle-Wittenberg, Halle, Germany

22. Anne Mlocek

    University Hospital Leipzig

    Affiliation as printed

    Institute for Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany

23. Stefan Moritz

    University Hospital in Halle

    Affiliation as printed

    Section of Clinical Infectious Diseases, University Hospital Halle, Halle, Germany

24. Ariadna Pérez Garriga Aachen Institute of Medical Informatics

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany

25. Lo An Phan-Vogtmann

    Jena University Hospital

    Affiliation as printed

    Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany

26. Diana Pietzner

    University Hospital in Halle

    Affiliation as printed

    IT Department, Data Integration Center, University Hospital Halle, Halle, Germany

27. Mathias Wilhelm Pletz

    Jena University Hospital · Friedrich Schiller University Jena

    Affiliation as printed

    Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany

28. Mario Popp

    University Hospital in Halle

    Affiliation as printed

    Section of Clinical Infectious Diseases, University Hospital Halle, Halle, Germany

29. Maike Rebenstorff

    University Hospital Leipzig

    Affiliation as printed

    Institute for Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany

30. Florian Rißner

    Friedrich Schiller University Jena

    Affiliation as printed

    Center for Clinical Studies, Friedrich-Schiller-University Jena, Jena, Germany

31. Rainer Röhrig Aachen Institute of Medical Informatics

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany

32. Kutaiba Saleh

    Jena University Hospital

    Affiliation as printed

    Data Integration Center, Jena University Hospital, Jena, Germany

33. Cord Spreckelsen

    Jena University Hospital

    Affiliation as printed

    Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany

34. Abel Stolz

    Leipzig University

    Affiliation as printed

    Center for Medical Informatics, Data Integration Center, University of Leipzig Medical Center, Leipzig, Germany

35. Susanne Thon

    Jena University Hospital

    Affiliation as printed

    Institute of Medical Microbiology, Jena University Hospital, Jena, Germany

36. Daniel Tiller

    University Hospital in Halle

    Affiliation as printed

    IT Department, Data Integration Center, University Hospital Halle, Halle, Germany

37. Sebastian Uschmann

    Jena University Hospital

    Affiliation as printed

    Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany

38. Sebastian Wendt

    University Hospital in Halle

    Affiliation as printed

    Hospital Hygiene Staff Unit, University Hospital Halle (Saale), Halle, Germany

39. Thomas Georg Wendt

    Leipzig University

    Affiliation as printed

    Center for Medical Informatics, Data Integration Center, University of Leipzig Medical Center, Leipzig, Germany

40. Philipp Winnekens

    Essen University Hospital

    Affiliation as printed

    Central IT Department, Data Integration Center, University Hospital Essen, Essen, Germany

41. Oliver Witzke

    Essen University Hospital · University of Duisburg-Essen

    Affiliation as printed

    Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany

42. Stefan Hagel

    Jena University Hospital · Friedrich Schiller University Jena

    Affiliation as printed

    Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany

43. André Scherag

    Jena University Hospital

    Affiliation as printed

    Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany