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Impact of computerized provider order entry (CPOE) on length of stay and mortality

View Article: PubMed Central - PubMed

ABSTRACT

Objective:: To examine changes in patient outcome variables, length of stay (LOS), and mortality after implementation of computerized provider order entry (CPOE).

Materials and methods:: A 5-year retrospective pre-post study evaluated 66 186 patients and 104 153 admissions (49 683 pre-CPOE, 54 470 post-CPOE) at an academic medical center. Generalized linear mixed statistical tests controlled for 17 potential confounders with 2 models per outcome.

Results:: After controlling for covariates, CPOE remained a significant statistical predictor of decreased LOS and mortality. LOS decreased by 0.90 days, P < .0001. Mortality decrease varied by model: 1 death per 1000 admissions (pre = 0.006, post = 0.0005, P < .001) or 3 deaths (pre = 0.008, post = 0.005, P < .01). Mortality and LOS decreased in medical and surgical units but increased in intensive care units.

Discussion:: This study examined CPOE at multiple levels. Given the inability to randomize CPOE assignment, these results may only be applicable to the local setting. Temporal trends found in this study suggest that hospital-wide implementations may have impacted nursing staff and new residents. Differences in the results were noted at the patient care unit and room levels. These differences may partly explain the mixed results from previous studies.

Conclusion:: Controlling for confounders, CPOE implementation remained a statistically significant predictor of LOS and mortality at this site. Mortality appears to be a sensitive outcome indicator with regard to hospital-wide implementations and should be further studied.

No MeSH data available.


Mean LOS by quarter
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ocw091-F4: Mean LOS by quarter

Mentions: Also found at the facility level was a gradual decrease in LOS over the course of the study (Figure 4). Quarter 4, the quarter after nursing documentation was implemented, showed a decrease below the trend line. There was an increase in LOS in quarters 8 and 15, which coincided with the arrival of new graduate medical trainees, and quarter 17, which coincided with winter (seasonal variation).Figure 4.


Impact of computerized provider order entry (CPOE) on length of stay and mortality
Mean LOS by quarter
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Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5391723&req=5

ocw091-F4: Mean LOS by quarter
Mentions: Also found at the facility level was a gradual decrease in LOS over the course of the study (Figure 4). Quarter 4, the quarter after nursing documentation was implemented, showed a decrease below the trend line. There was an increase in LOS in quarters 8 and 15, which coincided with the arrival of new graduate medical trainees, and quarter 17, which coincided with winter (seasonal variation).Figure 4.

View Article: PubMed Central - PubMed

ABSTRACT

Objective:: To examine changes in patient outcome variables, length of stay (LOS), and mortality after implementation of computerized provider order entry (CPOE).

Materials and methods:: A 5-year retrospective pre-post study evaluated 66 186 patients and 104 153 admissions (49 683 pre-CPOE, 54 470 post-CPOE) at an academic medical center. Generalized linear mixed statistical tests controlled for 17 potential confounders with 2 models per outcome.

Results:: After controlling for covariates, CPOE remained a significant statistical predictor of decreased LOS and mortality. LOS decreased by 0.90 days, P < .0001. Mortality decrease varied by model: 1 death per 1000 admissions (pre = 0.006, post = 0.0005, P < .001) or 3 deaths (pre = 0.008, post = 0.005, P < .01). Mortality and LOS decreased in medical and surgical units but increased in intensive care units.

Discussion:: This study examined CPOE at multiple levels. Given the inability to randomize CPOE assignment, these results may only be applicable to the local setting. Temporal trends found in this study suggest that hospital-wide implementations may have impacted nursing staff and new residents. Differences in the results were noted at the patient care unit and room levels. These differences may partly explain the mixed results from previous studies.

Conclusion:: Controlling for confounders, CPOE implementation remained a statistically significant predictor of LOS and mortality at this site. Mortality appears to be a sensitive outcome indicator with regard to hospital-wide implementations and should be further studied.

No MeSH data available.