Researchers at Lucile Packard Children's Hospital and Stanford University School of Medicine are saying a new study shows – for the first time – that using a computerized physician order entry system can significantly decrease hospital-wide mortality rates.
A CPOE system that was launched at Packard Children's in 2007 was correlated with a 20 percent decrease in mortality rates at the hospital over an 18-month period, according to the study, which was published in Pediatrics.
Researchers say CPOE can provide doctors with crucial data and suggestions that can help guide clinical decisions. "We've seen a 20 percent improvement in the time from order to administration for 'stat' [immediate] medications," said lead author Christopher Longhurst, MD, medical director of clinical informatics at Packard Children's and assistant clinical professor of pediatrics at Stanford. "This can have life-saving consequences."
"Prior to our report, no hospital or medical institution has shown that CPOE can be implemented and actually have an associated decline in mortality," said Longhurst. "But what we found is that CPOE implementation was statistically correlated with fewer patient deaths. As you can imagine, this is very meaningful."
Longhurst and his colleagues, made up of a team of eight researchers from Packard Children's, Stanford and Harvard University, reviewed nearly 100,000 discharges from Packard Children's from Jan. 1, 2001, through April 30, 2009. They compared the observed mortality with the expected mortality, which was generated from a database of 42 tertiary-care, not-for-profit pediatric hospitals similar to Packard Children's.
The result of their analysis was a finding of two fewer deaths per 1,000 discharges at Packard Children's in the period after CPOE was implemented, a total of 36 lives over 18 months.
Researchers noted that other patient care initiatives at the hospital may also have contributed to this important change. Longhurst emphasized that the new results show a correlation, not a cause and effect. "Our implementation of CPOE was executed superbly, but in addition, we were simultaneously making other advances in patient care," he said. "These included process and workflow changes, adjustments in ICU staffing, the rollout of Rapid Response Teams, the implementation of a nursing residency and more, all in the face of rising acuity in the hospital."
"Simply purchasing a fancy and expensive electronic medical records system in and of itself is not likely to make much of a positive impact on quality or patient safety," added Paul Sharek, MD, medical director of quality management and chief clinical patient safety officer at Packard Children's. "What provides the real opportunities for improving care is using this technology to support best practice, such as displaying relevant blood test results at the time physicians are ordering medications, or allowing practice guidelines to be immediately available to physicians at the time of order entry," said Sharek, who is an assistant professor of pediatrics at the medical school, and the study's senior author.
Mark Del Beccaro, MD, a pediatrics professor and vice chair for clinical affairs at Seattle Children's Hospital, who was not involved in this study, said he welcomed the new findings. Seattle Children's Hospital implemented CPOE in 2003. "Three years later a study of the effects showed mortality rates at our institution held steady," Del Beccaro said. "As the evolution and maturity of these systems and their benefits are being realized, there has been soft evidence that they improve patient safety. The Packard Children's report is the first I am aware of to show that you can potentially affect mortality by putting CPOE in place. This is an important study, and we hope others can realize these benefits."