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E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

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Impact of a computerized physician order-entry system.

William M Stone¹, Benn E Smith, Judd D Shaft

¹Department of Neurology, Division of Vascular Surgery, Mayo Clinic, Phoenix, AZ 85525, USA. william@mayo.edu

Journal of the American College of Surgeons

|May 30, 2009

Summary

Computerized physician order entry (CPOE) systems can significantly improve efficiency in surgical patient care. However, further refinements are needed to enhance patient safety measures with this technology.

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Area of Science:

Health Informatics
Surgical Patient Management
Electronic Prescribing Systems

Background:

The Institute of Medicine recommends widespread adoption of electronic prescribing systems.
Computerized Physician Order Entry (CPOE) systems require thorough evaluation, especially in surgical settings.
Previous studies on CPOE benefits have yielded mixed results, with no specific reviews for surgical patients.

Purpose of the Study:

To evaluate the implementation and impact of CPOE in managing surgical patients.
To assess changes in patient safety, efficiency, and resource utilization post-CPOE implementation.
To provide insights into the practical application of CPOE in an academic multispecialty practice.

Main Methods:

Retrospective and prospective analysis of patient safety metrics before and after CPOE implementation.
Evaluation of medication errors, order-implementation times, and operational efficiencies.
Direct observation to assess the time taken for order placement processes.

Main Results:

Medication errors remained comparable pre- and post-CPOE (0.22% vs. 0.16%-0.21%).
Order-to-nurse receipt time dramatically decreased from 41.2 minutes to 27 seconds with CPOE (p < 0.01).
Significant personnel efficiencies were observed, with 19.6% of ancillary positions eliminated, though temporary IT support was needed.

Conclusions:

Current CPOE technology offers substantial gains in operational efficiency for surgical practices.
Improvements in patient safety metrics require further technological refinements.
CPOE implementation in surgical patient management is feasible and can lead to significant time savings.