Does extended CPOE use reduce patient length of stay?. (January 2017)

• Record Type: Journal Article
• Authors: Romanow, Darryl; Rai, Arun; Keil, Mark; Luxenberg, Steven
• Is Part Of: International journal of medical informatics. Volume 97(2017)
• Page Start: 128
• Page End: 138
• Publication Date: 2017-01
• Subjects: CPOE -- Meaningful use -- Deep structure use -- Risk adjusted length of stay; Medical informatics -- Periodicals; Information science -- Periodicals; Computers -- Periodicals; Medical technology -- Periodicals; Medical Informatics -- Periodicals; Technology, Medical -- Periodicals; Computers; Information science; Medical informatics; Medical technology; Electronic journals; Periodicals; Electronic journals; 610.285
• DOI: 10.1016/j.ijmedinf.2016.09.012
• Languages: English
• ISSNs: 1386-5056

Abstract

Highlights: Using archival data from two affiliated hospitals in the Southeastern United States, we examined the impact of CPOE use on the discrepancy between patients' actual and expected length of stay (LOS) for five different patient conditions. CPOE orders, documentation entries, patient record lookups, order set adherence, alert acknowledgement, and progress note entries were used to assess clinicians'deep structure use (DSU) of CPOE. Increased DSU of CPOE reduced actual versus expected LOS for all five patient conditions. Core team DSU reduced actual versus expected LOS for 93% of the patients. Capturing feature-level clinician use of CPOE by patient condition enables improved assessment of the impact of CPOE. Abstract: Objective: This study compares use of Computerized Provider Order Entry (CPOE) and related clinical systems (i.e., extended CPOE) across 796 clinical teams caring for five distinct patient conditions. Our focus is the relationship between clinical teams' extended CPOE use and extent of prolonged stay (EPS), defined as the deviation in patients' observed length of stay from expected risk-adjusted length of stay. Materials and methods: Using archival data from two affiliated hospitals in the Southeastern United States, we focused on five different patient conditions of varying mortality risk (vaginal birth, knee/hip replacement, cardiovascular surgery, organ transplant and pneumonia). For each patient, we (1) differentiated between the following three types of care team members—Responsible physician, Core team (excluding the responsible physician), and Support team, (2) created a composite of CPOE orders, documentation entries, patient record lookups, order set adherence, alert acknowledgement, and progress note entries to assess the deep structure use (DSU) of CPOE by the three types of members in the patients' care team, and (3) aggregated DSU of CPOE across all three types of care team members to calculate Total team DSU. Results: Teams with higher Total team DSU of CPOE had lower EPS for all five patient conditions. Patients of Core teams with higher DSU of CPOE had lower EPS in all conditions except organ transplant, comprising 93% of the patients studied. Higher DSU of CPOE by all three clinician types significantly reduced EPS for vaginal birth and knee/hip replacement, whereas higher DSU by two of the three types of care team members significantly reduced EPS for cardiovascular surgery and pneumonia. Conclusions: Our results suggest that a clinician team that uses CPOE in a comprehensive manner is better informed enabling the team to coordinate care more effectively, resulting in reduced EPS.