Computerized Provider Order Entry with Pager Notification Improves Efficiency in STAT Radiographic Studies and Respiratory Treatments

Abstract

Background: The use of computerized provider order entry (CPOE) has been widely linked to improvements in patient safety. We hypothesized that electronic routing of CPOE-generated orders through individual pagers would improve the efficiency of STAT radiographic studies and respiratory treatments.

Methods: The study was conducted in two periods before and after implementing pager notification of STAT orders. In the Baseline Period, CPOE-generated STAT orders were communicated to radiology technicians or respiratory therapists through the use of printed orders, manual paging and/or telephone communication. The time to process the order and deliver a radiology result or respiratory treatment was tracked. In the Intervention Period CPOE-generated STAT orders were electronically routed to the radiology technician's or respiratory therapist's pager. During both time periods, clinicians completed user satisfaction surveys.

Results: Using pager notification, there was a significant reduction in radiology technician arrival time (16.8±2.1 vs 7.9±0.7 mins, p<0.001). Similarly there was a significant reduction in the cumulative time required to capture the radiographic image, image availability in the picture archiving and communication system (PACS) and the verbal report from the radiologist (p<0.05). The time required in obtaining a preliminary or final radiographic written report and the total cycle times were not significantly reduced. For STAT respiratory therapy orders there was a significant reduction in the mean time from ordering to administration of respiratory therapy treatments (124.7±14.1 vs 49.8±11.4 minutes, p<0.01). Radiologists, respiratory therapists and ordering clinicians reported improved satisfaction after implementation of pager notification.

Conclusion: Computer-generated orders for STAT radiographic studies and respiratory treatments can be carried out significantly faster through the use of direct pager notification. The implementation of this process has resulted in improved care delivery and widespread clinician satisfaction.

Keywords: Care orders; Computerized provider order entry; Efficiency; Radiology; Respiratory therapy.

Figure 1

CPOE radiology ordering process. STAT radiology orders are entered into ICIS via a wireless device and are routed directly to the STAT radiology technician’s pager. The technician arrives to take the radiograph and the image is then available in PACS.

Figure 2

CPOE radiology ordering process. STAT radiology orders are entered into ICIS via a wireless device and are routed directly to the STAT radiology technician’s pager. The technician arrives to take the radiograph and the image is then available in PACS.

Figure 3

Respiratory therapy order processing before and after implementation of the pager notification system. The time expended contacting the respiratory therapist is avoided with pager notification. RT=respiratory therapist, PT=physical therapy

Figure 4

Time to completion for each of six stages during a ‘STAT’ radiographic order study (Baseline Period – dark bars, and Pager Notification Period – light bars). The Baseline Period represents the mean time required for each stage in 27 studies. Pager Notification Period represents the mean time required for each stage in 20 studies. Stage 1 = time from STAT order to technicians arrival, Stage 2 = time from technicians arrival to obtaining the radiographic image, Stage 3 = time to image available for viewing in the PACS system, Stage 4=time to verbal radiologist report, Stage 5 =time to preliminary written report, and Stage 6 = time to final written report. * = p < 0.05 for cumulative results, # = p<0.05 for stepwise results.