Effects of Computerised Decision Support Systems on Nursing Performance and Patient Outcomes: A Systematic Review

Objective: To examine the effect of computerised decision support systems (CDSS) on nursing performance and patient outcomes. Data sources: 15 databases including Medline and CINAHL were searched up to May 2006, together with reference lists of included studies and relevant reviews. Review methods: Randomised 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: 8 studies, 3 comparing nurses using CDSS with nurses not using CDSS and 5 comparing nurses using CDSS with other health professionals not using CDSS, were included. Risk of contamination was a concern in 4 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 randomisation is at the practitioner or the unit level. Future systematic reviews should focus on particular uses of CDSS.