Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric...

Area of Science:

• Medical Informatics
• Pediatric Critical Care

Background:

• A recent report indicated a rise in mortality following the implementation of computerized physician order entry (CPOE) systems in critically ill pediatric transport populations.
• This observation raised concerns about the safety and impact of CPOE in vulnerable pediatric patient groups.

Purpose of the Study:

• To investigate whether the implementation of CPOE was associated with an increase in mortality among pediatric patients directly admitted to neonatal and pediatric intensive care units.
• To compare mortality rates during two 6-month periods before CPOE implementation with one 6-month period after implementation.

Main Methods:

• The study was conducted in the pediatric and neonatal intensive care units at Montefiore Medical Center.
• Data were collected on all patients admitted directly to these units from the emergency room, operating room, or as transfers.
• Mortality rates were compared between pre-CPOE and post-CPOE periods, with adjustments for confounding covariates.

Main Results:

• Overall mortality was 3.16% in the pre-CPOE period (917 patients) and 2.41% in the post-CPOE period (374 patients), with no statistically significant difference (p = .466).
• Significant risk factors for mortality included shock, prematurity, male gender, and hematologic/oncologic diagnoses.
• After adjusting for all covariates, CPOE initiation was not associated with increased mortality (odds ratio, 0.71; 95% confidence interval, 0.32-1.57).

Conclusions:

• The implementation of computerized physician order entry (CPOE) in this pediatric intensive care unit setting was not associated with an increase in patient mortality.
• The findings suggest that CPOE can be safely implemented in pediatric intensive care units without adversely affecting survival rates.