Computerized provider order entry implementation: No association with increased mortality rates in an intensive care unit
Computerized provider order entry implementation: No association with increased mortality rates in an intensive care unit
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DOI：
10.1542/peds.2006-0367
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发表时间：
2006-07-01
期刊：
影响因子：
8
通讯作者：
Eisenberg, MA
中科院分区：
文献类型：
--
作者：
Del Beccaro, MA;Jeffries, HE;Eisenberg, MA
OBJECTIVE.我们的目标是确定在我们的PICU中实施计算机化供应商订单输入系统后，风险调整死亡率是否有任何变化。方法。研究在三级护理PICU进行，该ICU有20张病床，每年收治1100例患者。回顾性地从PICUE数据库中提取了2002年10月1日至2004年12月31日期间所有入院的人口统计数据、入院来源、初步诊断、粗死亡率和儿科死亡风险III风险调整死亡率。这一时间段反映了计算机化供应商订单输入实施之前和之后的13个月。儿科死亡风险III死亡风险校正用于确定标准化死亡率。在研究期间，2533名患者被送入PICU，其中284名患者是从另一家机构转运过来的。实施前13个月的死亡率为4.22%，实施后13个月的死亡率为3.46%，表明实施后死亡风险无显著降低。标准化死亡率分别为0.98和0.77，转运患者的死亡率为9.6%和6.29%。这导致在实施后期间死亡率风险降低不显著。标准化死亡率比实施前为1.10，实施后为0.70。对实施前13个月与实施后5个月的分析显示，所有PICU患者和转运患者的死亡率下降趋势无统计学意义。实施计算机化的供应商订单输入系统，即使在实施后的最初几个月，与死亡率的增加无关。我们的经验表明，即使在ICU环境中，精心的设计、构建、实施和支持也可以降低实施新技术的风险。
OBJECTIVE. Our goal was to determine if there were any changes in risk-adjusted mortality after the implementation of a computerized provider order entry system in our PICU.METHODS. Study was undertaken in a tertiary care PICU with 20 beds and 1100 annual admissions. Demographic, admission source, primary diagnosis, crude mortality, and Pediatric Risk of Mortality III risk-adjusted mortality were abstracted retrospectively on all admissions from the PICUEs database for the period October 1, 2002, to December 31, 2004. This time period reflects the 13 months before and 13 months after computerized provider order entry implementation. Pediatric Risk of Mortality III mortality risk adjustment was used to determine standardized mortality ratios.RESULTS. During the study period, 2533 patients were admitted to the PICU, of which 284 were transported from another facility. The 13-month preimplementation mortality rate was 4.22%, and the 13-month postimplementation mortality rate was 3.46%, representing a nonsignificant reduction in the risk of mortality in the postimplementation period. The standardized mortality ratio was 0.98 vs 0.77, respectively, and the mortality rate for the transported patients was 9.6% vs 6.29%. This yields a nonsignificant mortality risk reduction in the postimplementation period. The standardized mortality ratio was 1.10 preimplementation versus 0.70 postimplementation. Analysis of the 13-month preimplementation versus 5-month postimplementation periods showed a non-statistically significant trend in reduction of mortality for all PICU patients and for transported patients.CONCLUSIONS. Implementation of a computerized provider order entry system, even in the early months after implementation, was not associated with an increase in mortality. Our experience suggests that careful design, build, implementation, and support can mitigate the risk of implementing new technology even in an ICU setting.