Order set project reduces length of stay at Canadian hospitals

A study of the Grey Bruce Health Network's Order Set project, which used standardized, Web-based order sets, shows improvements in the length of stay, ordering of best practices and reduced readmissions.

The project began in March 2007 when Toronto-based GBHN partnered with the Open Source Order Set Network (OSOS) to standardize and improve care in the network's 11 hospitals. Since then, GBHN has been able to develop and implement more than 100 evidence-based best practice order sets in all areas of patient care.

Order sets are treatment templates used to generate orders for patients. Patients admitted to the hospital using order sets, compared with those admitted without order sets, showed the following benefits:

  • Length of stay was reduced by almost one full day (from 5.84 to 4.88 days);
  • Unscheduled readmissions during the first week of discharge were reduced by almost 50 percent;
  • The ordering of more than 100 best-practice medications, investigations, consults and treatments was improved.

"We are very excited about these results," said Jessica Meleskie, who headed the project. "The GBHN Order Set project has created a durable foundation for sustained quality improvement in a very cost effective way. Our Order Set project is a key success factor for our computerized physician order entry project (CPOE) and we plan to continue to develop the use of order sets at GBHN."

The study reviewed 1,847 charts from February 2008 to February 2009. Ten areas of care were examined – acute coronary syndrome, Caesarean section, COPD, congestive heart failure, pneumonia, febrile neutopenia, fractured hip, stroke, hip replacement and vaginal birth. The review included all hospitals in the network.

The network is a voluntary formal collaboration of five corporations: Grey Bruce Health Services (six hospital sites), Hanover and District Hospital (one hospital), South Bruce Grey Health Centre (four hospital sites), Grey Bruce Health Unit and the South West Community Care Access Centre (CCAC).

Order sets improved the ordering of many key quality aspects of care, often dramatically increasing the use of evidence-based best practices. For example, the use of acetylsalicylic acid (ASA) chewable tablets is known to reduce the chance of death when administered to patients with acute coronary syndrome (heart attack). The Grey Bruce audit showed that physicians using order sets were 143 percent more likely to order ASA using an order set compared to those who did use an order set.

The more than 90 hospitals on the OSOS Network will be able to benefit from the work done by GBHN, according to OSOS Network executives.