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
✗✓?✓ ✗✓? ✗
