Eight studies were included in the review. Sample sizes were reported but it was not always clear whether nurses or patients were being referred to; the authors stated that more than 100 nurses and 24,000 patients participated in the included studies.
The assessment of study quality showed a risk of contamination in 4 studies.
Studies using a comparison group of nurses not using CDSS (3 studies).
In one study the use of CDSS improved performance on three out of four outcomes, while in a second study it was associated with poorer performance outcomes. None of the 3 studies showed any significant impact on patient outcomes measured by prothrombin levels or glucose levels within recommended ranges.
Studies using a comparison group of other health professionals not using CDSS (5 studies).
Three RCTs compared nurses using CDSS with doctors in anticoagulation management, and none found a significant difference in patient outcomes. Performance outcomes showed a statistically significant increase in one study, with an RD for acceptance of dose and interval advice of 0.19 (95% CI: 0.09, 0.29, p=0.00) dependent on patient variables. Two studies of triage for first contact care found that CDSS had a statistically significant benefit when assessed by performance outcomes: one found a reduction in general practitioner (GP) telephone advice as final point of contact (RD 0.34, 95% CI: 0.33, 0.36, p=0.00), while the other found a similar reduction in GP appointments (RD 0.23, 95% CI: 0.20, 0.26, p=0.00). One showed a negative effect on patient outcomes measured by visits to accident and emergency, out-of-hours consultations and return consultations (data not reported), while another showed some positive impact on patient outcomes measured by adverse effects including hospital admissions within 3 days (RD 0.01, 95% CI: 0.00, 0.02, p=0.02) and within 24 hours (RD 0.01, 95% CI: 0.00, 0.02, p=0.04). There was no significant effect on accident and emergency attendance or deaths.
Further details of individual performance and patient outcomes were reported in the paper.