Cargando…
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...
Autores principales: | , , , , , |
---|---|
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 |
_version_ | 1782220229864062976 |
---|---|
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. |
format | Online Article Text |
id | pubmed-3248372 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT aldorzihasanm impactofcomputerizedphysicianorderentrycpoesystemontheoutcomeofcriticallyilladultpatientsabeforeafterstudy AT tamimhanim impactofcomputerizedphysicianorderentrycpoesystemontheoutcomeofcriticallyilladultpatientsabeforeafterstudy AT cherfanantoine impactofcomputerizedphysicianorderentrycpoesystemontheoutcomeofcriticallyilladultpatientsabeforeafterstudy AT hassanmohamada impactofcomputerizedphysicianorderentrycpoesystemontheoutcomeofcriticallyilladultpatientsabeforeafterstudy AT tahersaadi impactofcomputerizedphysicianorderentrycpoesystemontheoutcomeofcriticallyilladultpatientsabeforeafterstudy AT arabiyaseenm impactofcomputerizedphysicianorderentrycpoesystemontheoutcomeofcriticallyilladultpatientsabeforeafterstudy |