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

BACKGROUND: Computerized 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. METHODS: This was an obse...

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Autores principales: Al-Dorzi, Hasan M, Tamim, Hani M, Cherfan, Antoine, Hassan, Mohamad A, Taher, Saadi, Arabi, Yaseen M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248372/
https://www.ncbi.nlm.nih.gov/pubmed/22098683
http://dx.doi.org/10.1186/1472-6947-11-71
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author Al-Dorzi, Hasan M
Tamim, Hani M
Cherfan, Antoine
Hassan, Mohamad A
Taher, Saadi
Arabi, Yaseen M
author_facet Al-Dorzi, Hasan M
Tamim, Hani M
Cherfan, Antoine
Hassan, Mohamad A
Taher, Saadi
Arabi, Yaseen M
author_sort Al-Dorzi, Hasan M
collection PubMed
description BACKGROUND: Computerized 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. METHODS: This 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. RESULTS: There 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. CONCLUSIONS: The 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.
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spelling pubmed-32483722011-12-30 Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study Al-Dorzi, Hasan M Tamim, Hani M Cherfan, Antoine Hassan, Mohamad A Taher, Saadi Arabi, Yaseen M BMC Med Inform Decis Mak Research Article BACKGROUND: Computerized 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. METHODS: This 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. RESULTS: There 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. CONCLUSIONS: The 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. BioMed Central 2011-11-19 /pmc/articles/PMC3248372/ /pubmed/22098683 http://dx.doi.org/10.1186/1472-6947-11-71 Text en Copyright ©2011 Al-Dorzi et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Al-Dorzi, Hasan M
Tamim, Hani M
Cherfan, Antoine
Hassan, Mohamad A
Taher, Saadi
Arabi, Yaseen M
Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study
title Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study
title_full Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study
title_fullStr Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study
title_full_unstemmed Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study
title_short Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study
title_sort impact of computerized physician order entry (cpoe) system on the outcome of critically ill adult patients: a before-after study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248372/
https://www.ncbi.nlm.nih.gov/pubmed/22098683
http://dx.doi.org/10.1186/1472-6947-11-71
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