Abandoned Inpatient Orders: An Opportunity for Improving CPOE Safety and Efficiency

Abandoned medication orders-those initiated but not signed-represent a potential safety risk and an indicator of electronic health record (EHR) inefficiency. This study explores inpatient medication abandonment across two large tertiary healthcare systems using different EHRs.Silent alerts were deployed to identify abandoned orders at Site 1 (June 2018-May 2019) and Site 2 (July 2020-May 2023). At Site 1, alerts triggered on all inpatient medication orders. At Site 2, alerts were part of a broader study implementing indication alerts; only orders for study medications triggered alerts. An abandoned order was defined as an order initiated but not signed within 24 hours of initiation. We calculated abandonment rates and rates of reorders, and performed regression to examine the association between abandonment and clinician, patient, and order characteristics. Exponential models were fit to characterize the chronology of reordering.Among 6.8 million medication orders, abandonment rates were 11.2% at Site 1 and 25.0% at Site 2. Due to fundamental differences in alert configuration and order capture, no direct statistical comparison of abandonment rates between the two sites was conducted. Over half of abandoned orders were reordered within 24 hours (65.3% at Site 1; 54.2% at Site 2). The chronology of reordering was similar at both institutions. Attendings, the most senior clinicians, had the lowest rates of abandonment. Abandonment rates decreased as clinicians placed more orders, but rose as clinicians ordered on more unique patients. Abandonments were higher when ordering for children compared with adults.Order abandonment is common and varies by patient's age, clinician type, and workload. Abandonment rates declined as house staff providers advanced in training, signifying clinical experience plays a role. Frequent reordering suggests that workflow interruptions or modifications, rather than intentional medication cancellation, may lead to a significant proportion of abandonments. Similarity in the timing of reordering between healthcare systems suggest common reordering processes across sites. Our findings demonstrate significant order abandonment rates, with the potential to use abandonment as a metric to improve computerized provider order entry (CPOE) functionality, clinicians' workflows, and patient safety.