Western Journal of Emergency Medicine (Mar 2013)

Implementation of Computerized Physician Order Entry for Critical Patients in an Academic Emergency Department is Not Associated with a Change in Mortality Rate

  • Doug D. Brunette,
  • Jean Tersteeg,
  • Nicholas Brown,
  • Valerie Johnson,
  • Stephen Dunlop,
  • James Karambay,
  • James Miner

Journal volume & issue
Vol. 14, no. 2
pp. 114 – 120

Abstract

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Introduction: There is limited literature on the effect of computerized physician order entry(CPOE) on mortality. The objective of our study was to determine if there was a change inmortality among critically ill patients presenting to the emergency department (ED) after theimplementation of a CPOE system.Methods: This was a retrospective study of all critically ill patients in the ED during the yearbefore and the year after CPOE implementation. The primary outcome measures were mortalityin the ED, after admission, and overall. Secondary outcome measures included length of stay inthe resuscitation area of the ED, length of hospital stay, and disposition following hospitalization.Patient disposition was used as a marker for neurologic function, and patients were grouped aseither being discharged to home vs. nursing home, rehabilitation center, or a long-term healthcarefacility. We analyzed data using descriptive statistics, chi- square, and Wilcoxon rank sum tests.Results: There were 2,974 critically ill patients in the year preceding CPOE and 2,969 patientsin the year following CPOE implementation. There were no differences in mortality between thetwo groups in the ED, after admission, or overall. The pre- and post-CPOE mortality rate for theED, hospital, or overall was 2.52% vs. 2.02% (P = 0.19, 95% confidence interval [CI] -0.3 to 1.3),7.8% versus 8.29% (P = 0.61, 95% CI -1.9 to 0.9), and 10.32% vs. 10.31% (P = .60, 95% CI -1.5to 1.6), respectively. There was no difference in hospital length of stay between pre- and post-CPOE patients (3 days versus 3 days), a difference of 0.05 days (95% CI -0.47 to 0.57). Lengthof stay in the ED resuscitation area was longer in the post-CPOE group (31 versus 32 minutes), adifference of -1.96 minutes (95% CI -3.4 to -0.53). More patients were discharged to home in thepre-CPOE group (66.8% versus 64.3%), a difference of 2.54% (95% CI 0.13% to 4.96%).Conclusion: The implementation of CPOE was not associated with a change in mortality ofcritically ill ED patients, but was associated with a decrease in proportion of patients discharged tohome after hospitalization.

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