{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T10:43:04Z","timestamp":1791715384731,"version":"4.3.4"},"reference-count":115,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health and Social Care Delivery Research (HSDR) Programme","doi-asserted-by":"publisher","award":["NIHR127926"],"award-info":[{"award-number":["NIHR127926"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Soc Care Deliv Res"],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title>\n<jats:p>Computerised decision support systems (CDSS) are widely used by nurses and allied health professionals but their effect on clinical performance and patient outcomes is uncertain.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-2\"><jats:title>Objectives<\/jats:title>\n<jats:p>Evaluate the effects of clinical decision support systems use on nurses\u2019, midwives\u2019 and allied health professionals\u2019 performance and patient outcomes and sense-check the results with developers and users.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-3\"><jats:title>Eligibility criteria<\/jats:title>\n<jats:p>Comparative studies (randomised controlled trials (RCTs), non-randomised trials, controlled before-and-after (CBA) studies, interrupted time series (ITS) and repeated measures studies comparing) of CDSS versus usual care from nurses, midwives or other allied health professionals.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-4\"><jats:title>Information sources<\/jats:title>\n<jats:p>Nineteen bibliographic databases searched October 2019 and February 2021.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-5\"><jats:title>Risk of bias<\/jats:title>\n<jats:p>Assessed using structured risk of bias guidelines; almost all included studies were at high risk of bias.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-6\"><jats:title>Synthesis of results<\/jats:title>\n<jats:p>Heterogeneity between interventions and outcomes necessitated narrative synthesis and grouping by: similarity in focus or CDSS-type, targeted health professionals, patient group, outcomes reported and study design.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-7\"><jats:title>Included studies<\/jats:title>\n<jats:p>Of 36,106 initial records, 262 studies were assessed for eligibility, with 35 included: 28 RCTs (80%), 3 CBA studies (8.6%), 3 ITS (8.6%) and 1 non-randomised trial, a total of 1318 health professionals and 67,595 patient participants. Few studies were multi-site and most focused on decision-making by nurses (71%) or paramedics (5.7%). Standalone, computer-based CDSS featured in 88.7% of the studies; only 8.6% of the studies involved \u2018smart\u2019 mobile or handheld technology. Care processes \u2013 including adherence to guidance \u2013 were positively influenced in 47% of the measures adopted. For example, nurses\u2019 adherence to hand disinfection guidance, insulin dosing, on-time blood sampling, and documenting care were improved if they used CDSS. Patient care outcomes were statistically \u2013 if not always clinically \u2013 significantly improved in 40.7% of indicators. For example, lower numbers of falls and pressure ulcers, better glycaemic control, screening of malnutrition and obesity, and accurate triaging were features of professionals using CDSS compared to those who were not.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-8\"><jats:title>Evidence limitations<\/jats:title>\n<jats:p>Allied health professionals (AHPs) were underrepresented compared to nurses; systems, studies and outcomes were heterogeneous, preventing statistical aggregation; very wide confidence intervals around effects meant clinical significance was questionable; decision and implementation theory that would have helped interpret effects \u2013 including null effects \u2013 was largely absent; economic data were scant and diverse, preventing estimation of overall cost-effectiveness.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-9\"><jats:title>Interpretation<\/jats:title>\n<jats:p>CDSS can positively influence selected aspects of nurses\u2019, midwives\u2019 and AHPs\u2019 performance and care outcomes. Comparative research is generally of low quality and outcomes wide ranging and heterogeneous. After more than a decade of synthesised research into CDSS in healthcare professions other than medicine, the effect on processes and outcomes remains uncertain. Higher-quality, theoretically informed, evaluative research that addresses the economics of CDSS development and implementation is still required.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-10\"><jats:title>Future work<\/jats:title>\n<jats:p>Developing nursing CDSS and primary research evaluation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-11\"><jats:title>Funding<\/jats:title>\n<jats:p>This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in Health and Social Care Delivery Research; 2023. See the NIHR Journals Library website for further project information.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-12\"><jats:title>Registration<\/jats:title>\n<jats:p>PROSPERO 1 [number: CRD42019147773].<\/jats:p>\n<\/jats:sec>","DOI":"10.3310\/grnm5147","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T10:53:08Z","timestamp":1689850388000},"page":"1-93","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["The effects of computerised decision support systems on nursing and allied health professional performance and patient outcomes: a systematic review and user contextualisation"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9369-1204","authenticated-orcid":true,"given":"Carl","family":"Thompson","sequence":"first","affiliation":[{"name":"School of Healthcare, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4821-2304","authenticated-orcid":true,"given":"Teumzghi","family":"Mebrahtu","sequence":"additional","affiliation":[{"name":"School of Healthcare, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6173-0117","authenticated-orcid":true,"given":"Sarah","family":"Skyrme","sequence":"additional","affiliation":[{"name":"School of Healthcare, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-9854","authenticated-orcid":true,"given":"Karen","family":"Bloor","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2059-4662","authenticated-orcid":true,"given":"Deidre","family":"Andre","sequence":"additional","affiliation":[{"name":"Library Services, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0926-0397","authenticated-orcid":true,"given":"Anne Maree","family":"Keenan","sequence":"additional","affiliation":[{"name":"School of Healthcare, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Ledward","sequence":"additional","affiliation":[{"name":"School of Healthcare, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3985-986X","authenticated-orcid":true,"given":"Huiqin","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Healthcare, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5856-4912","authenticated-orcid":true,"given":"Rebecca","family":"Randell","sequence":"additional","affiliation":[{"name":"Faculty of Health Studies, University of Bradford, Bradford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2024,10]]},"reference":[{"key":"key2024110911245900_ref1-bib1","author":"Thompson"},{"key":"key2024110911245900_ref2-bib2","doi-asserted-by":"crossref","first-page":"596","DOI":"10.7326\/0003-4819-103-4-596","article-title":"Information needs in office practice: are they being met? 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