Background: Computerized   physician order entry (CPOE) systems are designed to increase safety and   improve quality of care; however, their impact on efficiency in the ED has   not yet been validated. This study examined the impact of CPOE on process   times for medication delivery, laboratory utilization and diagnostic imaging   in the early, late and control phases of a regional ED-CPOE implementation. 

Setting: Three tertiary care   hospitals serving a population in excess of 1 million inhabitants that   initiated the same CPOE system during the same 3-week time window. Patients   were stratified into three groupings: Control, Early CPOE and Late CPOE (n =   200 patients per group/hospital site). Eligible patients consisted of a   stratified (40% CTAS 2 and 60% CTAS 3) random sample of all patients seen 30   days preceding CPOE implementation (Control), 30 days immediately after CPOE   implementation (Early CPOE) and 5-6 months after CPOE implementation (Late   CPOE). Primary outcomes were time to (TT) from physician assignment (MD-sign)   up to MD-order completion. An ANOVA and t-test were employed for statistical   analysis. 

Results: In   comparison with control, TT 1st MD-Ordered Medication decreased in both the   Early and Late CPOE groups (102.6 min control, 62.8 Early and 65.7 late, p   < 0.001). TT 1st MD-ordered laboratory results increased in both the Early   and Late CPOE groups compared to Control (76.4, 85.3 and 73.8 min,   respectively, p < 0.001). TT 1st X-Ray also significantly increased in   both the Early and Late CPOE groups (80.4, 84.8 min, respectively, compared   to 68.1, p < 0.001). Given that CT and ultrasound imaging inherently takes   increased time, these imaging studies were not included, and only X-ray was   examined. There was no statistical difference found between TT discharge and   consult request. 

Conclusions: Regional implementation of CPOE afforded important   efficiencies in time to medication delivery for high acuity ED patients.   Increased times observed for laboratory and radiology results may reflect   system issues outside of the emergency department and as a result of   potential confounding may not be a reflection of CPOE impact.

Authors: Shahbaz Syed, Dongmei Wang, Debbie Goulard, Tom Rich, Grant Innes, Eddy Lang