To identify Clinical Decision Support Software (CDSS) that have been implemented in hospital which aim to influence empirical antibiotic prescribing, and to establish their impact on antibiotic prescribing and patient outcomes.

Systematic review & meta-analysis.

MEDLINE, Cochrane Central Register of Controlled Trials and Embase were searched from their inception to February 2024.

Studies evaluating the impact of digital CDSS with the primary purpose of influencing initial empirical antibiotic prescribing for patients with acute infection in hospital.

Study characteristics, intervention characteristics and outcome data were extracted independently by two reviewers. Outcomes were grouped into four domains including clinical outcomes (mortality, length of stay, readmission rates), antibiotic appropriateness (guideline adherence, coverage of causative organism), antimicrobial stewardship and health economics. Risk of bias assessment was conducted using Risk of Bias In Non-randomised Studies - of Interventions for non-randomised studies and Cochrane Risk of Bias 2 for randomised studies. Outcome data with sufficient reporting and homogeneity were synthesised quantitatively using a random-effects meta-analysis; other outcomes were synthesised qualitatively.

15 full texts met the eligibility criteria after screening 7984 unique studies. Low-quality evidence suggested that implementation of CDSS was associated with lower mortality (OR 0.76, 95% CI 0.57 to 1.01) and improved adherence to antibiotic prescribing guidelines (OR 1.75, 95% CI 1.26 to 2.43). No change in length of stay or readmission rates were observed. Coverage of the causative organism was similar after CDSS implementation (OR 1.26, 95% CI 0.97 to 1.63). High-quality evidence supported the association between CDSS implementation and reduced broad-spectrum antibiotic prescribing.

CDSS can be used to reduce the unnecessary prescribing of broad-spectrum antibiotics. Further high-quality studies are required to establish whether their implementation also results in improvements in other outcomes.

CRD42024501185.

People living with multiple long-term conditions (MLTC) admitted to hospital have worse outcomes and report lower satisfaction with care. Understanding how people living with MLTC admitted to the hospital are cared for is a key step in redesigning systems to better meet their needs. This scoping review aimed to identify existing evidence regarding clinical decision-making and care pathways for people with MLTC admitted to the hospital. In addition, we described research methods used to investigate hospital care for people living with MLTC.

A scoping review methodological framework formed the basis of this review. We took a narrative approach to describe our study findings.

A search of Medline, Embase and PsycInfo electronic databases in July 2024 captured relevant literature published from 1996 to 2024.

Studies that explored care pathways and clinical decision-making for people living with MLTC or co-morbidities, studies conducted fully or primarily in secondary or tertiary care published in English Language and with full text available.

Titles and abstracts were independently screened by two authors. Extracted data included country of origin, aims, study design, any use of an analytical framework or design, type of analyses performed, setting, participant group, number of participants included, health condition(s) studied and main findings. Included studies were categorised as either: studies reviewing existing literature, studies reviewing guidance, studies utilising qualitative methods or ‘other’.

A total of 521 articles were screened, 17 of which met the inclusion criteria. We identified a range of investigative methods. Eight studies used qualitative methods (interviews or focus groups), four were guideline reviews, four were literature reviews and one was classified as ‘other’. Often, researchers choose to combine methods, gathering evidence both empirically and from reviews of existing evidence or guidelines. However, none of the empirical qualitative studies directly or solely investigated clinical decision-making when treating people living with MLTC in acute care and the emergency department. Studies identified complexities in care for people living with MLTC, and some authors attempted to make their own recommendations or draft their own guidance to counter these.

This scoping review highlights the limitations of the current evidence base, which, while diverse in methods, provides sparse insights into clinical decision-making and care pathways for people living with MLTC admitted to hospital. Further research is recommended, including reviews of guidelines and gathering insights from both healthcare professionals and people living with MLTC.