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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.


Mortality rate per 1000 visits per fiscal quarter
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ocw091-F5: Mortality rate per 1000 visits per fiscal quarter

Mentions: Quarters 1–10 represent the pre-CPOE phase and quarters 11–20 represent the post phase. April and May of 2009 are excluded from the analyses due to the extended implementation taking place during these months. Quarter 11 contains an extra month (June 2009) and represents the end of the implementation phase. Figure 5 shows that the pre-CPOE mortality rate ranged from 13.81 to 22.40, while the post-implementation rate ranged from 15.90 to 19.35, a decrease from 8.59 to 3.45. Figure 5 also shows pertinent events that occurred during the course of the study. In the pre phase, mortality spiked during the nursing documentation implementation, and again when the new residents arrived. In the post-CPOE phase, mortality fell from 21.11 to 17.20 immediately after the implementation phase and in each quarter when new residents arrived.Figure 5.


Impact of computerized provider order entry (CPOE) on length of stay and mortality
Mortality rate per 1000 visits per fiscal quarter
© Copyright Policy - cc-by-nc
Related In: Results  -  Collection

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

ocw091-F5: Mortality rate per 1000 visits per fiscal quarter
Mentions: Quarters 1–10 represent the pre-CPOE phase and quarters 11–20 represent the post phase. April and May of 2009 are excluded from the analyses due to the extended implementation taking place during these months. Quarter 11 contains an extra month (June 2009) and represents the end of the implementation phase. Figure 5 shows that the pre-CPOE mortality rate ranged from 13.81 to 22.40, while the post-implementation rate ranged from 15.90 to 19.35, a decrease from 8.59 to 3.45. Figure 5 also shows pertinent events that occurred during the course of the study. In the pre phase, mortality spiked during the nursing documentation implementation, and again when the new residents arrived. In the post-CPOE phase, mortality fell from 21.11 to 17.20 immediately after the implementation phase and in each quarter when new residents arrived.Figure 5.

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.