PEDIATRICS Vol. 118 No. 1 July 2006, pp. 290-295 (doi:10.1542/peds.2006-0367)
Computerized Provider Order Entry Implementation: No Association With Increased Mortality Rates in an Intensive Care Unit
Children's Hospital and Regional Medical Center, Seattle, Washington
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.
Key Words: CPOE • ICU • mortality
Abbreviations: EMR—electronic medical record • CPOE—computerized provider order entry • CHRMC—Children's Hospital and Regional Medical Center • CHP—Children's Hospital of Pittsburgh • PRISM—Pediatric Risk of Mortality • RR—relative risk • CI—confidence interval • SMR—standardized mortality ratio
Accepted Mar 29, 2006.
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