Prospero Protocol
A rapid evidence review of digital fragmentation and patient safety outcomes with respect to antimicrobial prescribing
Please visit PROSPERO for the full protocol
Review title
A rapid evidence review of digital fragmentation and patient safety outcomes with respect to antimicrobial prescribing
Condition or domain being studied
Digital fragmentation and fragmented health information exchange refer to the dispersal and lack of integration of patient data across multiple, often incompatible, digital systems and platforms within the healthcare system, or information that is presented in a fragmented, inefficient, or unusable manner that hinders clinical workflows, decision-making, and patient care.
Rationale for the review
Patients attend multiple healthcare providers for a variety of reasons, including the need for specialist services, patient choice and emergency admission. However, many NHS secondary care trusts do not share the same electronic healthcare record systems (EHRS), and integration between primary and secondary car is often lacking. Whilst, some of the patient data from other sites is available through portals, it is not always straightforward to access and requires time and effort to compile a comprehensive history.
Effective data sharing is important in supporting high quality antimicrobial prescribing for patients who present with infections in hospital. Previous patterns of antimicrobial resistance or prior use of antibiotics can influence the choice of initial antibiotics and infection control policy. When a patient's recent care includes multiple providers, antimicrobial prescriptions and microbiology results can make the information difficult to access, potentially leading to sub-optimal antimicrobial prescribing decisions. As microbiology tests can often take a few days to return a result, the correct antimicrobial choice may be delayed meaning effective therapy is not instituted.
This evidence review aims to synthesise existing peer-reviewed literature on the scale and impact of digital health fragmentation within the NHS and other countries, specifically in relation to antimicrobial prescribing, resistance, and stewardship. It will also examine proposed strategies and interventions to address this fragmentation and its impact on antimicrobial prescribing.
Review objectives
RESEARCH QUESTION(S)
What is the extent of digital health fragmentation in the NHS?
What impact does digital fragmentation have on prescribing practices and patient safety outcomes, specifically in relation to antimicrobial prescribing?
What solutions or interventions have been proposed or implemented to reduce digital fragmentation in this context?
What evidence exists regarding the effectiveness of these solutions in improving patient safety outcomes, specifically in relation to antimicrobial prescribing and resistance?
Last updated