Medical Microbiology, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Medical Microbiology, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
BMJ Open Qual. 2023 Jan;12(1). doi: 10.1136/bmjoq-2022-002143.
Relevant clinical information is vital to inform the analytical and interpretative phases of most investigations. The aim of this study is to evaluate the impact of implementation of computerised provider order entry (CPOE), featuring order-specific electronic order entry forms (eOEFs), on the quality and quantity of clinical information included with investigation requests.
The CPOE module of a commercially available electronic health record (Cerner Millennium) was implemented at a large, tertiary care centre. The laboratory information management system was interrogated to collect data on specimens sent for microbiological culture 1 year before implementation of CPOE (2018), immediately post implementation (2019) and 6 months post implementation (2020). An interrupted time series analysis was performed, using text mining, to evaluate the quality and quantity of free-text clinical information.
In total, 39 919 specimens were collected from 16 458 patients. eOEFs were used to place 10 071 out of 13 735 orders in 2019 (73.3%), and 9155 out of 12 229 orders in 2020 (74.9%). No clinical details were included with 653 out of 39 919 specimens (1.6%), of which 22 (3.4%) were ordered using eOEFs. The median character count increased from 14 in 2018, to 41 in 2019, and 38 in 2020. An anti-infective agent was specified in 581 out of 13 955 requests (4.2%) in 2018; 5545 out of 13 735 requests (40.4%) in 2019; and 5215 out of 12 229 requests (42.6%) in 2020. Ciprofloxacin or piperacillin-tazobactam (Tazocin) were mentioned in the clinical details included with 421 out of 15 335 urine culture requests (2.7%), of which 406 (96.3%) were ordered using eOEFs. Subsequent detection of in vitro non-susceptibility led to a change in anti-infective therapy for five patients.
Implementation of CPOE, featuring order-specific eOEFs, significantly and sustainably improves the quality and quantity of clinical information included with investigation requests, resulting in changes to patient management that would not otherwise have occurred.
相关的临床信息对于大多数检验的分析和解释阶段至关重要。本研究旨在评估实施计算机化医嘱录入（CPOE），包括特定医嘱的电子医嘱录入表单（eOEF），对检验申请中包含的临床信息的质量和数量的影响。
在一家大型的三级保健中心实施了一款商业化的电子病历（Cerner Millennium）的 CPOE 模块。通过查询实验室信息管理系统收集了在实施 CPOE 前一年（2018 年）、实施后立即（2019 年）和实施后 6 个月（2020 年）送检的微生物培养标本的数据。使用文本挖掘进行了中断时间序列分析，以评估自由文本临床信息的质量和数量。
共收集了 16458 名患者的 39919 份标本。在 2019 年，使用 eOEF 下达了 13735 个医嘱中的 10071 个（73.3%），在 2020 年下达了 12229 个医嘱中的 9155 个（74.9%）。有 39919 份标本中没有包括任何临床信息（占 1.6%），其中 22 份（3.4%）是使用 eOEF 下达的医嘱。字符数中位数从 2018 年的 14 个增加到 2019 年的 41 个，再到 2020 年的 38 个。在 2018 年，有 13955 个检验申请中（占 4.2%）指定了抗感染药物；在 2019 年，有 13735 个检验申请中（占 40.4%）指定了抗感染药物；在 2020 年，有 12229 个检验申请中（占 42.6%）指定了抗感染药物。在 15335 份尿液培养申请中，有 421 份（2.7%）包括了临床详细信息，其中 406 份（96.3%）是使用 eOEF 下达的医嘱，提到了环丙沙星或哌拉西林他唑巴坦（Tazocin）。随后，由于体外药敏检测结果不敏感，5 名患者的抗感染治疗方案发生了改变。
实施 CPOE，包括特定医嘱的 eOEF，显著且可持续地改善了检验申请中包含的临床信息的质量和数量，从而改变了患者的管理，否则这些改变不会发生。
