Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
Pediatrics. 2010 Jul;126(1):14-21. doi: 10.1542/peds.2009-3271. Epub 2010 May 3.
Implementations of computerized physician order entry (CPOE) systems have previously been associated with either an increase or no change in hospital-wide mortality rates of inpatients. Despite widespread enthusiasm for CPOE as a tool to help transform quality and patient safety, no published studies to date have associated CPOE implementation with significant reductions in hospital-wide mortality rates.
The objective of this study was to determine the effect on the hospital-wide mortality rate after implementation of CPOE at an academic children's hospital.
We performed a cohort study with historical controls at a 303-bed, freestanding, quaternary care academic children's hospital. All nonobstetric inpatients admitted between January 1, 2001, and April 30, 2009, were included. A total of 80,063 patient discharges were evaluated before the intervention (before November 1, 2007), and 17,432 patient discharges were evaluated after the intervention (on or after November 1, 2007). On November 4, 2007, the hospital implemented locally modified functionality within a commercially sold electronic medical record to support CPOE and electronic nursing documentation.
After CPOE implementation, the mean monthly adjusted mortality rate decreased by 20% (1.008-0.716 deaths per 100 discharges per month unadjusted [95% confidence interval: 0.8%-40%]; P = .03). With observed versus expected mortality-rate estimates, these data suggest that our CPOE implementation could have resulted in 36 fewer deaths over the 18-month postimplementation time frame.
Implementation of a locally modified, commercially sold CPOE system was associated with a statistically significant reduction in the hospital-wide mortality rate at a quaternary care academic children's hospital.
计算机化医嘱录入系统（CPOE）的实施以前与住院患者的全医院死亡率的增加或没有变化有关。尽管人们普遍对 CPOE 作为帮助提高质量和患者安全的工具充满热情，但迄今为止没有发表的研究将 CPOE 的实施与全医院死亡率的显著降低联系起来。
本研究旨在确定在学术儿童医院实施 CPOE 对全医院死亡率的影响。
我们在一家拥有 303 张床位的独立四级保健学术儿童医院进行了一项队列研究，设有历史对照组。所有非产科住院患者均于 2001 年 1 月 1 日至 2009 年 4 月 30 日期间入院。在干预前（2007 年 11 月 1 日之前）共评估了 80063 例患者出院，在干预后（2007 年 11 月 1 日或之后）评估了 17432 例患者出院。2007 年 11 月 4 日，医院在商业销售的电子病历中实施了本地修改的功能，以支持 CPOE 和电子护理文件。
在 CPOE 实施后，每月调整后的平均死亡率下降了 20%（未调整的每月每 100 出院人次死亡率为 1.008-0.716 死亡/人[95%置信区间：0.8%-40%]；P=.03）。根据观察到的死亡率与预期死亡率的估计，这些数据表明，我们的 CPOE 实施可能导致在实施后的 18 个月内减少 36 例死亡。
在一家四级保健学术儿童医院实施本地修改的、商业销售的 CPOE 系统与全医院死亡率的统计学显著降低相关。
