Clinical decision systems are getting more and more specialized and their capacity to integrate clinical data, sometimes in real time, brings new opportunity to interact with the prescribers at a higher level.
Available systems can identify sub-optimal prescription with simple rules like the identification of broad-spectrum or costly antimicrobials for a limited duration, switch from intravenous (IV) to oral treatments in patients capable of ingesting other oral drugs and receiving a minimal duration of IV antimicrobial beforehand. Beyond the capacity to continue refining these rules by integrating additional criteria to increase the alerts’ specificity, a new trend is emerging: the syndromic approach.
Advanced knowledge and extended clinical variables integration give the prescribers the ability to go further in patients’ management. For instance, in the classical approach, a patient with a methicillin-susceptible Staphylococcus aureus positive blood culture will generate alerts if he is not on a current antimicrobial, is the dosage is insufficient, if he receives a combination of redundant spectrum antimicrobials, or is he has significant interactions with other current drugs. In the syndromic approach, global aspects of clinical management will be targeted. Does the patient have the criteria for a shorter IV treatment (no metastatic foci of infection, no endocarditis, IV catheters are removed, no persistent bacteremia, favorable clinical evolution, etc.)? Or in the eventuality of endocarditis, are surgical criteria that would hasten a transfer to a tertiary care center present? Other syndromes are also approachable with the same logic: candidemia, Clostridioides difficile infections, urinary tract infections, etc.
By structuring the clinical knowledge, by reminding the user of the next important clinical steps to achieve, in maximizing the use of real-time data: clinical decision systems provide the tools to improve the quality and the security of the care delivered.