Specificity of computerized physician order entry has a significant effect on the efficiency of workflow for critically ill patients

Abstract

Background: Critically ill patients require rapid care, yet they are also at risk for morbidity from the potential complications of that care. Computerized physician order entry (CPOE) is advocated as a tool to reduce medical errors, improve the efficiency of healthcare delivery, and improve outcomes. Little is known regarding the essential attributes of CPOE in the intensive care unit (ICU).

Objective: To assess the effect of CPOE on ICU patient care.

Design: Retrospective before and after cohort study.

Setting: An academic ICU.

Patients: Patients admitted to the ICU during use of the initial CPOE application and those admitted after its modification.

Interventions: Comprehensive order interface redesign improving clarity, specificity, and efficiency.

Measurements: Orders for complex ICU care were compared between the two groups. In addition, the use of higher-efficiency CPOE order paths was tracked.

Results: Patients treated with both the initial and modified CPOE system were similar for all measured characteristics. With the modified CPOE system, there were significant reductions in orders for vasoactive infusions, sedative infusions, and ventilator management. There was also a significant increase in orders executed through ICU-specific order sets after system modifications.

Limitations: This retrospective study cannot assess issues related to learner expertise and is meant to only suggest the importance of developing CPOE systems that are appropriate for specialty care environments.

Conclusion: Appropriate CPOE applications can improve the efficiency of care for critically ill patients. The workflow requirements of individual units must be analyzed before technologies like CPOE can be properly developed and implemented.