Study: CPOE may lower mortality rates
Implementation of a locally modified, commercially sold computer physician order entry (CPOE) system was associated with a statistically significant reduction in the hospital-wide mortality rate at a quaternary care academic children’s hospital, according to research from a recent article in Pediatrics.
The researchers, led by Christopher Longhurst, MD, medical director of clinical informatics at Lucille Packard Children's Hospital (LPCH), in Palo Alto, Calif., and assistant clinical professor of pediatrics at Stanford University School of Medicine, showed for the first time that a significant decrease in hospital-wide mortality rates can be associated with implementation of a CPOE system.
The system, launched at the hospital in 2007, was correlated with a 20 percent decrease in mortality rates at LPCH over an 18-month period, according to the article. The researchers noted that other patient care initiatives at the hospital may also have contributed to this change.
To determine if the mortality rates changed, Longhurst and his colleagues reviewed 97,495 hospital discharges from Jan. 1, 2001, through April 30, 2009 and compared the observed mortality with the expected mortality, which was generated from a database of 42 tertiary-care, nonprofit pediatric hospitals similar to LPCH.
According to the findings, there were two fewer deaths per 1,000 discharges at the hospital in the period after CPOE was implemented--a total of 36 lives during 18 months.
There was no significant difference between pre-CPOE and post-CPOE populations on the basis of patient gender, yet statistically significant differences were noted for age, severity of illness as represented by case-mix index and race/ethnicity, with fewer individuals identified as white or of unknown ethnicity and more Hispanic and Asian individuals in the post-intervention group, the report noted.
“There was a significant increase in length in stay during the post-implementation period,” the report added.
Mean monthly unadjusted mortality rates before and after the intervention were 1.008 and 0.716 deaths per 100 discharges, respectively.
"Prior to our report, no hospital or medical institution has shown that CPOE can be implemented and actually have an associated decline in mortality," said Longhurst. "But what we found is that CPOE implementation was statistically correlated with fewer patient deaths."
The researchers emphasized that the results show a correlation, not a cause and effect.
"The potential implications of these findings on national mortality statistics in children are dramatic,” concluded the study. “Future research should focus on replicating these findings in other inpatient settings and populations and evaluating the cost-effectiveness of this intervention.”
The researchers, led by Christopher Longhurst, MD, medical director of clinical informatics at Lucille Packard Children's Hospital (LPCH), in Palo Alto, Calif., and assistant clinical professor of pediatrics at Stanford University School of Medicine, showed for the first time that a significant decrease in hospital-wide mortality rates can be associated with implementation of a CPOE system.
The system, launched at the hospital in 2007, was correlated with a 20 percent decrease in mortality rates at LPCH over an 18-month period, according to the article. The researchers noted that other patient care initiatives at the hospital may also have contributed to this change.
To determine if the mortality rates changed, Longhurst and his colleagues reviewed 97,495 hospital discharges from Jan. 1, 2001, through April 30, 2009 and compared the observed mortality with the expected mortality, which was generated from a database of 42 tertiary-care, nonprofit pediatric hospitals similar to LPCH.
According to the findings, there were two fewer deaths per 1,000 discharges at the hospital in the period after CPOE was implemented--a total of 36 lives during 18 months.
There was no significant difference between pre-CPOE and post-CPOE populations on the basis of patient gender, yet statistically significant differences were noted for age, severity of illness as represented by case-mix index and race/ethnicity, with fewer individuals identified as white or of unknown ethnicity and more Hispanic and Asian individuals in the post-intervention group, the report noted.
“There was a significant increase in length in stay during the post-implementation period,” the report added.
Mean monthly unadjusted mortality rates before and after the intervention were 1.008 and 0.716 deaths per 100 discharges, respectively.
"Prior to our report, no hospital or medical institution has shown that CPOE can be implemented and actually have an associated decline in mortality," said Longhurst. "But what we found is that CPOE implementation was statistically correlated with fewer patient deaths."
The researchers emphasized that the results show a correlation, not a cause and effect.
"The potential implications of these findings on national mortality statistics in children are dramatic,” concluded the study. “Future research should focus on replicating these findings in other inpatient settings and populations and evaluating the cost-effectiveness of this intervention.”