Handler Jonathan A, Feied Craig F, Coonan Kevin, Vozenilek John, Gillam Michael, Peacock Peter R, Sinert Rich, Smith Mark S
Department of Emergency Medicine, Northwestern University School of Medicine, Chicago, IL 60611, USA.
Acad Emerg Med. 2004 Nov;11(11):1135-41. doi: 10.1197/j.aem.2004.08.007.
Computerized physician order entry (CPOE) and decision support systems (DSS) can reduce certain types of error but often slow clinicians and may increase other types of error. The net effect of these systems on an emergency department (ED) is unknown. The consensus participants combined published evidence with expert opinion to outline recommendations for success. These include seamless integration of CPOE and DSS into systems and workflow; ensuring access to Internet-based and other online support material in the clinical arena; designing systems specifically for the ED and measuring their impact to ensure an overall benefit; ensuring that CPOE systems provide error and interaction checking and facilitate weight- and physiology-based dosing; using interruptive alerts only for the highest-severity events; providing a simple, vendor-independent interface for institutional customization of CPOE alert thresholds; maximizing the use of automated systems and passive data capture; and ensuring the widespread availability of CPOE and DSS using secure wireless and portable technologies where appropriate. Decisions regarding CPOE and DSS in the ED should be guided by the ED chair or designee. Much of what is believed to be true regarding CPOE and DSS has not been adequately studied. Additional CPOE and DSS research is needed quickly, and this research should receive funding priority. DSS and CPOE hold great promise to improve patient care, but not all systems are equal. Evidence must guide these efforts, and the measured outcomes must consider the many factors of quality care.
计算机化医师医嘱录入（CPOE）和决策支持系统（DSS）可以减少某些类型的错误，但往往会使临床医生的工作速度变慢，并且可能增加其他类型的错误。这些系统对急诊科（ED）的总体影响尚不清楚。共识参与者将已发表的证据与专家意见相结合，以概述取得成功的建议。这些建议包括将CPOE和DSS无缝集成到系统和工作流程中；确保在临床环境中能够访问基于互联网的和其他在线支持材料；专门为急诊科设计系统并衡量其影响以确保总体受益；确保CPOE系统提供错误和交互检查，并便于基于体重和生理指标的给药；仅对最严重的事件使用中断性警报；提供一个简单的、与供应商无关的界面，以便机构定制CPOE警报阈值；最大限度地利用自动化系统和被动数据采集；并在适当情况下使用安全的无线和便携式技术确保CPOE和DSS的广泛可用性。关于急诊科CPOE和DSS的决策应由急诊科主任或其指定人员指导。许多关于CPOE和DSS的普遍看法尚未得到充分研究。需要迅速开展更多关于CPOE和DSS的研究，并且这项研究应获得资金优先支持。DSS和CPOE有望极大地改善患者护理，但并非所有系统都是一样的。必须以证据为这些努力提供指导，并且所衡量的结果必须考虑到优质护理的诸多因素。
