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Cited by 181Electronic Health Records SystemsHospital Admissions and OutcomesPatient Safety and Medication Errors

Computerized Provider Order Entry Implementation: No Association With Increased Mortality Rates in an Intensive Care Unit

Del Beccaro, Mark A., Jeffries, Howard E., Eisenberg, Matthew A., Harry, Eric D.·2006·Pediatrics
DOI 10.1542/peds.2006-0367
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Abstract

OBJECTIVE. Our goal was to determine if there were any changes in risk-adjusted mortality after the implementation of a computerized provider order entry system in our PICU. METHODS. Study was undertaken in a tertiary care PICU with 20 beds and 1100 annual admissions. Demographic, admission source, primary diagnosis, crude mortality, and Pediatric Risk of Mortality III risk-adjusted mortality were abstracted retrospectively on all admissions from the PICUEs database for the period October 1, 2002, to December 31, 2004. This time period reflects the 13 months before and 13 months after computerized provider order entry implementation. Pediatric Risk of Mortality III mortality risk adjustment was used to determine standardized mortality ratios. RESULTS. During the study period, 2533 patients were admitted to the PICU, of which 284 were transported from another facility. The 13-month preimplementation mortality rate was 4.22%, and the 13-month postimplementation mortality rate was 3.46%, representing a nonsignificant reduction in the risk of mortality in the postimplementation period. The standardized mortality ratio was 0.98 vs 0.77, respectively, and the mortality rate for the transported patients was 9.6% vs 6.29%. This yields a nonsignificant mortality risk reduction in the postimplementation period. The standardized mortality ratio was 1.10 preimplementation versus 0.70 postimplementation. Analysis of the 13-month preimplementation versus 5-month postimplementation periods showed a non–statistically significant trend in reduction of mortality for all PICU patients and for transported patients. CONCLUSIONS. Implementation of a computerized provider order entry system, even in the early months after implementation, was not associated with an increase in mortality. Our experience suggests that careful design, build, implementation, and support can mitigate the risk of implementing new technology even in an ICU setting.

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  • When multiple EHR components are integrated, interactions among them are a leading source of EHR-related flaws.

    “Indeed, where multiple EHR components are integrated (for example, order entry, nursing and pharmacy order processing, and medication administration documentation), one of the most important sources of EHR-related flaws is the interactions among the components.15”

    From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [15]

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Authors
Del Beccaro, M. A., Jeffries, H. E., Eisenberg, M. A., & Harry, E. D.
Affiliations
  • Children's Hospital and Regional Medical Center, Seattle, Washington
  • Seattle Children's Hospital (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2006-07-01
Volume
118
Issue
1
Pages
290-295
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2006-0367
OpenAlex
W2157069442
Cited by
181
References
11
Citations by year
2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 8 · 2020: 3 · 2019: 5 · 2018: 5 · 2017: 4 · 2016: 10 · 2015: 18 · 2014: 6 · 2013: 11 · 2012: 11
FWCI
44.35
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
computerized physician order entry, pediatric intensive care unit, mortality, risk-adjusted mortality, standardized mortality ratio, patient transport, electronic health records, technology implementation, patient safety
MeSH terms
Child, Humans, Intensive Care Units, Length of Stay, Outcome and Process Assessment, Health Care, Patient Transfer, Washington, Hospital Mortality, Risk Assessment, Decision Support Systems, Clinical, Risk Adjustment, Medical Order Entry Systems

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