Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. 1506-1512 (doi:10.1542/peds.2005-1287)
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Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System

Yong Y. Han, MD*,{ddagger}, Joseph A. Carcillo, MD*,{ddagger},§, Shekhar T. Venkataraman, MD*,{ddagger},§, Robert S.B. Clark, MD*,{ddagger},§, R. Scott Watson, MD, MPH*,{ddagger},§,||, Trung C. Nguyen, MD*,{ddagger}, Hülya Bayir, MD*,{ddagger} and Richard A. Orr, MD*,{ddagger},§

* Departments of Critical Care Medicine
§ Pediatrics
|| Clinical Research, Investigation, and Systems Modeling in Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
{ddagger} Department of Critical Care Medicine/Transport, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

Objective. In response to the landmark 1999 report by the Institute of Medicine and safety initiatives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physician order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hypothesis that CPOE implementation results in reduced mortality among children who are transported for specialized care.

Methods. Demographic, clinical, and mortality data were collected of all children who were admitted via interfacility transport to our regional, academic, tertiary-care level children’s hospital during an 18-month period. A commercially sold CPOE program that operated within the framework of a general, medical-surgical clinical application platform was rapidly implemented hospital-wide over 6 days during this period. Retrospective analyses of pre-CPOE and post-CPOE implementation time periods (13 months before and 5 months after CPOE implementation) were subsequently performed.

Results. Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94–5.55) after adjustment for other mortality covariables.

Conclusions. We have observed an unexpected increase in mortality coincident with CPOE implementation. Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when implementing CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies.

Key Words: administration • computer software • health care delivery/access • interhospital transport • outcome

Abbreviations: CPOE, computerized physician order entry • CHP, Children's Hospital of Pittsburgh • ADE, adverse drug event • PRISM, Pediatric Risk of Mortality • OR, odds ratio • CI, confidence interval

Accepted Sep 12, 2005.




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P3Rs:

Read all P3Rs

No Proven Link Between CPOE and Mortality
Ciaran S Phibbs, et al.
Pediatrics Online, 19 Dec 2005 [Full text]
Response to Article
Donald L Levick
Pediatrics Online, 23 Dec 2005 [Full text]
Re: No Proven Link Between CPOE and Mortality
John E.. Brimm, M.D..
Pediatrics Online, 29 Dec 2005 [Full text]
Response to Responses re: CPOE
Mark D. Bej, M.D.
Pediatrics Online, 8 Mar 2006 [Full text]