Computerized Physician Order Entry in the

Emergency Department

Can CPOE make me safer?

MortalityMedication errors

Mortality

Medication Errors

Study Decrease in Medication Error

Comments

Bates et al, 1999 81% Typical medications: antibioticsanalgesics

anticoagulantselectrolytes

Bates et al, 1998 57%

Sard et al, 2008 90%

Aronsky et al, 2007 91%

King et al, 2003 40% CHEO (SCM)

Upperman et al, 2005 Avoid 1 ADE q20d Pre-post differences

Holdsworth et al, 2007 Avoid 1 ADE q64d Very small numbers

Can CPOE make me safer?

Very limited ED dataMortalityMedication Errors

Can CPOE make me smarter?

Inpatient Evidence

Inpatient Evidence

Study No CDS CDS P Value

Evans et al, 1994 77% 94% <0.001

Paul et al, 2006Concurrent

RCT57%64%

70%73%

<0.0010.03

ED Evidence

ED Evidence

ED Evidence

Characteristic Pre-CPOE Post-CPOE P Value

Presence of a clinical question 34.8% 52.6% <0.0001

Information on prior diagnoses 51.1% 71.1% <0.01

Length (characters) 49.6 71.2 <0.05

Can CPOE make me smarter?

CDS functionalityAbxRenal dosingMedications in older patients

Improved communication to radiology

Can CPOE make me faster?

NO

Inpatient Evidence

Outpatient Evidence

CPO

E

Pape

r

ED Evidence

Activity Time Pre-CPOE Time Post-CPOE P Value

Staff order entry 5 min 9.5 min 0.01

Resident order entry 5.5 min 14.3 min 0.001

RN-staff communication 24.5 min 13.3 min 0.01

Can CPOE make me faster?

Not looking good…Inpatient dataOutpatient dataED data

Can CPOE improve ED flow?

Characteristic Pre-EMR/CPOE Time Post-EMR/CPOE Tme Pre-Post Difference

ED LOS 6.69 hrs 4.75 hrs 116 min

Lab turnaround time 2.03 hrs 1.44 hrs 35 min

X-ray turnaround time 55 min 44 min 11 min

CT turnaround time 3.64 hrs 1.74 hrs 114 min

Investigation Turnaround Times

Study Test Turnaround Time (min) Difference (min)

Pre-CPOE Post-CPOE

Guss et al, 2008Na

CBCTnI

46.742.241.8

37.236.330.6

9.55.9

11.2

Westbrook et al, 2008 35 25 10

Westbrook et al, 2006 73.8 58.3 15.5

Investigation Turnaround Times

ED Length of Stay

Can CPOE improve ED flow?

Not enough solid data on ED LOSPotential to improve test turnaround time

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