Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study.

Hasan M Al-Dorzi,Saadi Taher,Antoine Cherfan,Mohamad A Hassan,Yaseen M Arabi,Hani M Tamim

doi:10.1186/1472-6947-11-71

Abstract

BackgroundComputerized physician order entry (CPOE) systems are recommended to improve patient safety and outcomes. However, their effectiveness has been questioned. Our objective was to evaluate the impact of CPOE implementation on the outcome of critically ill patients.MethodsThis was an observational before-after study carried out in a 21-bed medical and surgical intensive care unit (ICU) of a tertiary care center. It included all patients admitted to the ICU in the 24 months pre- and 12 months post-CPOE (Misys®) implementation. Data were extracted from a prospectively collected ICU database and included: demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, admission diagnosis and comorbid conditions. Outcomes compared in different pre- and post-CPOE periods included: ICU and hospital mortality, duration of mechanical ventilation, and ICU and hospital length of stay. These outcomes were also compared in selected high risk subgroups of patients (age 12-17 years, traumatic brain injury, admission diagnosis of sepsis and admission APACHE II > 23). Multivariate analysis was used to adjust for imbalances in baseline characteristics and selected clinically relevant variables.ResultsThere were 1638 and 898 patients admitted to the ICU in the specified pre- and post-CPOE periods, respectively (age = 52 ± 22 vs. 52 ± 21 years, p = 0.74; APACHE II = 24 ± 9 vs. 24 ± 10, p = 0.83). During these periods, there were no differences in ICU (adjusted odds ratio (aOR) 0.98, 95% confidence interval [CI] 0.7-1.3) and in hospital mortality (aOR 1.00, 95% CI 0.8-1.3). CPOE implementation was associated with similar duration of mechanical ventilation and of stay in the ICU and hospital. There was no increased mortality or stay in the high risk subgroups after CPOE implementation.ConclusionsThe implementation of CPOE in an adult medical surgical ICU resulted in no improvement in patient outcomes in the immediate phase and up to 12 months after implementation.

Highlights

Computerized physician order entry (CPOE) systems are recommended to improve patient safety and outcomes
General characteristics of all patients In the 24 months pre-CPOE implementation (December 4, 2004 to December 3, 2006), 1638 patients were admitted to the intensive care unit (ICU) (13104 patient-days) compared to 898 patients (7274 patient-days) in the 12 months post-CPOE implementation (December 4, 2006 to December 3, 2007)
Vasopressors (50% vs. 36%, p < 0.0001) and mechanical ventilation (77% vs. 73%, p = 0.004) were used more commonly in the 24 months pre-CPOE compared to 12 month post-CPOE implementation

Summary

Introduction

Computerized physician order entry (CPOE) systems are recommended to improve patient safety and outcomes. Our objective was to evaluate the impact of CPOE implementation on the outcome of critically ill patients. Del Beccaro et al observed a statistically insignificant decrease in mortality from 4.2% to 3.46% in the 13month pre- and post-CPOE implementation [9]. Literature lacks information on the impact of CPOE implementation on the outcomes of adult critically ill patients. The objective of our study, conducted as a quality improvement project, was to evaluate the outcomes of critically ill patients after CPOE implementation in an adult ICU

Objectives

Methods

Results

Discussion

Conclusion