Computerized Physician Order Entry in the Emergency Department

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Computerized Physician Order Entry in the
Emergency Department
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Can CPOE make me safer?

• Mortality
• Medication errors

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Mortality
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Medication Errors
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Study Decrease in Medication Error Comments
Bates et al, 1999 81 Typical medications antibiotics analgesics anticoagulants electrolytes
Bates et al, 1998 57 Typical medications antibiotics analgesics anticoagulants electrolytes
Sard et al, 2008 90 Typical medications antibiotics analgesics anticoagulants electrolytes
Aronsky et al, 2007 91 Typical medications antibiotics analgesics anticoagulants electrolytes
King et al, 2003 40 CHEO (SCM)
Upperman et al, 2005 Avoid 1 ADE q20d Pre-post differences
Holdsworth et al, 2007 Avoid 1 ADE q64d Very small numbers
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Can CPOE make me safer?

• Very limited ED data
• Mortality
• Medication Errors

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Can CPOE make me smarter?
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Inpatient Evidence
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Inpatient Evidence
Study No CDS CDS P Value
Evans et al, 1994 77 94 lt0.001
Paul et al, 2006 Concurrent RCT 57 64 70 73 lt0.001 0.03
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ED Evidence
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ED Evidence
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ED Evidence
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Characteristic Pre-CPOE Post-CPOE P Value
Presence of a clinical question 34.8 52.6 lt0.0001
Information on prior diagnoses 51.1 71.1 lt0.01
Length (characters) 49.6 71.2 lt0.05
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Can CPOE make me smarter?

• CDS functionality
• Abx
• Renal dosing
• Medications in older patients
• Improved communication to radiology

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Can CPOE make me faster?
NO
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Inpatient Evidence
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Outpatient Evidence
CPOE
Paper
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ED Evidence
Activity Time Pre-CPOE Time Post-CPOE P Value
Staff order entry 5 min 9.5 min 0.01
Resident order entry 5.5 min 14.3 min 0.001
RN-staff communication 24.5 min 13.3 min 0.01
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Can CPOE make me faster?

• Not looking good
• Inpatient data
• Outpatient data
• ED data

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Can CPOE improve ED flow?
Characteristic Pre-EMR/CPOE Time Post-EMR/CPOE Tme Pre-Post Difference
ED LOS 6.69 hrs 4.75 hrs 116 min
Lab turnaround time 2.03 hrs 1.44 hrs 35 min
X-ray turnaround time 55 min 44 min 11 min
CT turnaround time 3.64 hrs 1.74 hrs 114 min
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Investigation Turnaround Times
Study Test Turnaround Time (min) Test Turnaround Time (min) Difference (min)
Study Pre-CPOE Post-CPOE Difference (min)
Guss et al, 2008 Na CBC TnI 46.7 42.2 41.8 37.2 36.3 30.6 9.5 5.9 11.2
Westbrook et al, 2008 35 25 10
Westbrook et al, 2006 73.8 58.3 15.5
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Investigation Turnaround Times
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ED Length of Stay
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Can CPOE improve ED flow?

• Not enough solid data on ED LOS
• Potential to improve test turnaround time

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