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

Abstract

Objective: A worrisome increase in mortality has been reported recently following the initiation of a computerized physician order entry (CPOE) system in a critically ill pediatric transport population. We tested the hypothesis that such a mortality increase did not occur after the initiation of CPOE in a pediatric population that was directly admitted to the neonatal and pediatric intensive care units at Montefiore Medical Center during two 6-month periods before CPOE and one 6-month period immediately after CPOE was initiated. Mortality in the pre- and post-CPOE time periods was compared, and adjustment for potentially confounding covariates was performed.

Setting: The pediatric and neonatal intensive care units at Montefiore Medical Center.

Patients: All patients admitted from the emergency room or operating room or as transfers from other institutions directly to the pediatric and neonatal intensive care units at Montefiore Medical Center.

Interventions: None.

Measurements and main results: Overall, 29 (3.16%) of the 917 patients in the pre-CPOE period and nine (2.41%) of the 374 patients in the post-CPOE period died during their hospital stay (p = .466). The power to detect the hypothesized mortality increase was 81.7%. The variables that remained significant risk factors for mortality after adjustment were shock (odds ratio, 9.41; 95% confidence interval, 2.90-30.49), prematurity (odds ratio, 3.57; 95% confidence interval, 1.74-7.30), male gender (odds ratio, 3.31; 95% confidence interval, 1.47-7.69), or a hematologic/oncologic diagnosis (odds ratio, 3.14; 95% confidence interval, 1.44-6.86). Post-CPOE initiation status remained unassociated with mortality after adjusting for all covariates (odds ratio, 0.71; 95% confidence interval, 0.32-1.57).

Conclusion: Mortality did not increase during CPOE initiation.