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医生医嘱录入(POE)系统对医生开单模式及患者住院时间的影响。

Impact of a physician's order entry (POE) system on physicians' ordering patterns and patient length of stay.

作者信息

Hwang Jee-In, Park Hyeoun-Ae, Bakken Suzanne

机构信息

Department of Medical Informatics, Columbia University, New York, NY, USA.

出版信息

Int J Med Inform. 2002 Nov 12;65(3):213-23. doi: 10.1016/s1386-5056(02)00044-8.

Abstract

OBJECTIVE

To investigate the impact of a physician's order entry (POE) system on physicians' ordering patterns and patient length of stay.

DESIGN

Prospective time series study at pre-POE, 3 months and 6 months after POE at a tertiary teaching hospital in Korea. The study period was from June 1999 to May 2000.

MEASUREMENTS

The number of orders (doctor's, PRN, medication, changed, canceled orders), number of tests (complete blood count, chemistry, chest X-ray, stat laboratory, serum electrolytes tests), appropriateness and length of patient stay were measured through chart review of 171 in-patients (liver disease, renal disease, gastrectomy, simple mastectomy).

RESULTS

The number of doctors' orders, PRN, and medication orders significantly increased after POE. The numbers of changed and canceled orders were not significantly different between pre- and post-POE. The number of stat lab tests significantly decreased after POE. There was no change in appropriateness of patients' hospital stay between pre- and post-POE. Length of stay significantly decreased (P=0.049).

CONCLUSION

POE contributed to improving the quality of care in two ways: improvement of auditability by recording the medical services for patients in more precise and transparent manner, and more appropriate utilization of resources by decreasing the number of stat diagnostic tests and length of stay.

摘要

目的

探讨医生医嘱录入(POE)系统对医生开医嘱模式及患者住院时间的影响。

设计

在韩国一家三级教学医院进行的前瞻性时间序列研究,研究时间为POE实施前、实施后3个月及6个月。研究时间段为1999年6月至2000年5月。

测量指标

通过对171例住院患者(肝病、肾病、胃切除术、单纯乳房切除术)的病历审查,测量医嘱数量(医生医嘱、必要时医嘱、用药医嘱、更改医嘱、取消医嘱)、检查项目数量(全血细胞计数、生化检查、胸部X光、急诊实验室检查、血清电解质检查)、医嘱合理性及患者住院时间。

结果

POE实施后,医生医嘱、必要时医嘱及用药医嘱数量显著增加。POE实施前后,更改医嘱和取消医嘱的数量无显著差异。POE实施后,急诊实验室检查数量显著减少。POE实施前后,患者住院的合理性没有变化。住院时间显著缩短(P = 0.049)。

结论

POE通过两种方式有助于提高医疗质量:以更精确和透明的方式记录患者的医疗服务,提高可审计性;通过减少急诊诊断检查数量和住院时间,更合理地利用资源。

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