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Published on: August 1, 2019
Computerized provider order entry implementation: no association with increased mortality rates in an intensive care
Mark A Del Beccaro1, Howard E Jeffries, Matthew A Eisenberg
1Children's Hospital and Regional Medical Center, Mail Stop B5520, 4800 Sandpoint Way NE, Seattle, Washington 98105, USA. mark.delbeccaro@seattlechildrens.org
Pediatrics
|July 5, 2006
Summary
Implementing a computerized provider order entry system in the Pediatric Intensive Care Unit (PICU) did not increase patient mortality. This study found no significant changes in risk-adjusted mortality after system implementation.
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Quality improvement in healthcare
Background:
- Computerized provider order entry (CPOE) systems are increasingly adopted in intensive care units (ICUs).
- Assessing the impact of CPOE on patient outcomes, specifically mortality, is crucial for safe implementation.
- Previous studies have shown mixed results regarding CPOE's effect on mortality in critical care settings.
Purpose of the Study:
- To evaluate changes in risk-adjusted mortality following the implementation of a CPOE system in a Pediatric Intensive Care Unit (PICU).
- To determine if CPOE implementation was associated with an increase or decrease in patient mortality.
- To assess the safety and impact of new technology adoption in a critical care environment.
Main Methods:
- Retrospective analysis of patient data from a 20-bed tertiary care PICU over a 26-month period (13 months pre- and 13 months post-CPOE implementation).
- Data abstracted included demographics, admission source, diagnosis, crude mortality, and Pediatric Risk of Mortality III (PRISM III) risk-adjusted mortality.
- Standardized mortality ratios (SMRs) were calculated to compare observed vs. expected mortality.
Main Results:
- A total of 2533 patients were admitted during the study period.
- The crude mortality rate decreased from 4.22% pre-implementation to 3.46% post-implementation, a nonsignificant reduction.
- The SMR decreased from 0.98 to 0.77, and mortality for transported patients also showed a nonsignificant reduction post-implementation.
Conclusions:
- Implementation of a CPOE system in the PICU was not associated with an increase in mortality.
- Careful planning, system design, build, implementation, and support are key to mitigating risks when introducing new technology in ICUs.
- The study suggests that CPOE can be safely implemented in PICUs without adversely affecting patient mortality outcomes.
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