Ali Naeem A, Mekhjian Hagop S, Kuehn P Lynn, Bentley Thomas D, Kumar Rajee, Ferketich Amy K, Hoffmann Stephen P
The Dorthy M. Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH, USA.
Crit Care Med. 2005 Jan;33(1):110-4. doi: 10.1097/01.ccm.0000150266.58668.f9.
Critically ill patients require rapid care, yet they are also at risk for morbidity from the potential complications of that care. Computerized physician order entry (CPOE) is advocated as a tool to reduce medical errors, improve the efficiency of healthcare delivery, and improve outcomes. Little is known regarding the essential attributes of CPOE in the intensive care unit (ICU).
To assess the effect of CPOE on ICU patient care.
Retrospective before and after cohort study.
An academic ICU.
Patients admitted to the ICU during use of the initial CPOE application and those admitted after its modification.
Comprehensive order interface redesign improving clarity, specificity, and efficiency.
Orders for complex ICU care were compared between the two groups. In addition, the use of higher-efficiency CPOE order paths was tracked.
Patients treated with both the initial and modified CPOE system were similar for all measured characteristics. With the modified CPOE system, there were significant reductions in orders for vasoactive infusions, sedative infusions, and ventilator management. There was also a significant increase in orders executed through ICU-specific order sets after system modifications.
This retrospective study cannot assess issues related to learner expertise and is meant to only suggest the importance of developing CPOE systems that are appropriate for specialty care environments.
Appropriate CPOE applications can improve the efficiency of care for critically ill patients. The workflow requirements of individual units must be analyzed before technologies like CPOE can be properly developed and implemented.
重症患者需要迅速治疗，但他们也因治疗潜在并发症而面临发病风险。计算机化医生医嘱录入系统（CPOE）被倡导作为一种减少医疗差错、提高医疗服务效率和改善治疗结果的工具。关于重症监护病房（ICU）中CPOE的基本属性知之甚少。
评估CPOE对ICU患者护理的影响。
回顾性前后队列研究。
一所学术性ICU。
在最初使用CPOE应用程序期间入住ICU的患者以及在其修改后入住的患者。
全面重新设计医嘱界面，提高清晰度、特异性和效率。
比较两组之间复杂ICU护理的医嘱。此外，追踪更高效率CPOE医嘱路径的使用情况。
使用最初和修改后的CPOE系统治疗的患者在所有测量特征方面相似。使用修改后的CPOE系统后，血管活性药物输注、镇静剂输注和呼吸机管理的医嘱显著减少。系统修改后，通过ICU特定医嘱集执行的医嘱也显著增加。
这项回顾性研究无法评估与学习者专业知识相关的问题，仅旨在表明开发适合专科护理环境的CPOE系统的重要性。
合适的CPOE应用可以提高重症患者的护理效率。在能够正确开发和实施CPOE等技术之前，必须分析各个单位的工作流程要求。
