Related Experiment Video
Updated: Aug 11, 2026
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Improved compliance with quality measures at hospital discharge with a computerized physician order entry system
Javed Butler1, Theodore Speroff, Patrick G Arbogast
1Cardiology Division, Department of Medicine, Vanderbilt University, VAMC, Nashville, TN, USA. javed.butler@vanderbilt.edu
Insights
Computerized physician order entry (CPOE) discharge tools improved adherence to quality measures for congestive heart failure (CHF) and acute myocardial infarction (AMI) patients. Non-medication compliance significantly increased with CPOE implementation.
Area of Science:
- Healthcare Quality Improvement
- Health Informatics
- Clinical Workflow Optimization
Background:
- Hospitalized patients with congestive heart failure (CHF) and acute myocardial infarction (AMI) quality of care assessments often rely on discharge medications and instructions.
- Computerized physician order entry (CPOE) tools offer a potential solution to enhance compliance with these critical quality measures.
Purpose of the Study:
- To evaluate the impact of implementing disease-specific CPOE discharge tools on adherence to quality measures for CHF and AMI patients.
- To assess changes in compliance with medication prescriptions and non-medication instructions post-CPOE implementation.
Main Methods:
- A comparative study design was employed, analyzing data from pre-CPOE (July 2001-June 2002) and CPOE (October 2002-September 2003) periods.
- Discharge data for 286-290 AMI patients and 595-656 CHF patients were examined.
- Compliance with quality measures including aspirin/beta-blocker use (AMI), ejection fraction determination/discharge instructions (CHF), and ACE inhibitor use/smoking cessation counseling (both) was assessed.
Main Results:
- While compliance with discharge medications remained high and unchanged, non-medication measures significantly improved with CPOE.
- Smoking cessation counseling compliance increased from 43% to 62% for CHF and 1% to 21% for AMI patients.
- Discharge instructions for CHF patients improved from 56% to 3% compliance.
Conclusions:
- Implementation of CPOE discharge tools positively impacted compliance with selected quality measures for AMI and CHF patients.
- Further research is needed to determine effective strategies for rapid provider adoption and integration of CPOE tools.
Background:
Most measures used to assess the quality of care of hospitalized patients with congestive heart failure (CHF) and acute myocardial infarction (AMI) involve discharge medications and instructions. Implementation of disease-specific computerized physician order entry (CPOE) discharge tools may improve compliance with these measures.
Methods:
We studied 286 versus 290 AMI and 595 versus 656 CHF discharges in the pre-CPOE (July 2001 to June 2002) and CPOE (October 2002 to September 2003) periods, respectively. Compliance with chosen quality measures (aspirin and beta-blocker use for AMI, ejection fraction determination and discharge instructions for CHF, and angiotensin-converting enzyme inhibitor use, and smoking cessation counseling for both) was assessed.
Results:
Compliance with recommended discharge medications was high at baseline and did not change significantly. Smoking cessation counseling (43% vs 1% for CHF and 62% vs 21% for AMI) and discharge instructions for CHF (56% vs 3%) improved significantly in the CPOE period. Overall, 63% of patients with CHF and AMI in the CPOE period were discharged using the tools. Compliance with prescription of recommended medications was 100% among eligible patients when CPOE was used; however, this improvement was due entirely to better documentation of contraindications in the CPOE period. The actual proportion of patients who received discharge prescriptions between the pre-CPOE and CPOE periods did not change: beta-blockers (85% vs 84%), angiotensin-converting enzyme inhibitor for AMI (77% vs 76%), and for CHF (56% vs 61%). However, nonmedication measures significantly improved when CPOE was used.
Conclusions:
Implementation of a CPOE discharge tool improved compliance with selected quality measures in patients with AMI and CHF. Effective methods of rapid implementation and acceptance of these tools by providers require further study.
Related Concept Videos
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:31Discharge Summary Forms
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
01:18Guidelines and Strategies for Safe Computer Charting
Maintain Confidentiality and Security:
01:26Methods of Documentation II: POMR
01:30Methods of Documentation VII: EMR
01:27Nursing Clinical Information System
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include: