Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review.

OBJECTIVE To examine the effect of computerized decision support systems (CDSSs) on nursing performance and patient outcomes. METHOD Fifteen databases, including Medline and CINAHL, were searched up to May 2006 together with reference lists of included studies and relevant reviews. Randomized controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies that assessed the effects of CDSS use by nurses in a clinical setting on measurable professional and/or patient outcomes were included. RESULTS Eight studies, three comparing nurses using CDSS with nurses not using CDSS and five comparing nurses using CDSS with other health professionals not using CDSS, were included. Risk of contamination was a concern in four studies. The effect of CDSS on nursing performance and patient outcomes was inconsistent. CONCLUSION The introduction of CDSS may not necessarily lead to a positive outcome; further studies are needed in order to identify contexts in which CDSS use by nurses is most effective. CDSS are complex interventions and should be evaluated as such; future studies should explore the impact of the users and the protocol on which the CDSS is based, reporting details of both. Contamination is a significant issue when evaluating CDSS, so it is important that randomization is at the practitioner or the unit level. Future systematic reviews should focus on particular uses of CDSS.