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The impact of computerized provider order entry on emergency department flow

  • Andrew Gray (a1), Christopher M.B. Fernandes (a1), Kristine Van Aarsen (a1) and Melanie Columbus (a1)
Abstract
Abstract Objectives

Computerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).

Methods

We conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.

Results

A significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.

Conclusions

CPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

RÉSUMÉ Objectif

Un système informatisé d’entrée des prescriptions (SIEP) par des professionnels autorisés a été mis sur pied afin d’améliorer la sécurité des patients en évitant les erreurs de médicaments; toutefois, on ne connaît pas l’incidence du système sur le roulement des patients au service des urgences (SU). Aussi les auteurs ont-ils examiné l’incidence de la mise sur pied du SIEP sur trois indicateurs de performance des SU, soit le délai d’attente (DA), la durée de séjour (DS) et la proportion de patients qui sont partis sans avoir vu de médecin.

Méthode

Une étude rétrospective de cohorte a été menée parmi tous les patients de 18 ans et plus qui ont consulté au SU du London Health Sciences Centre, en juillet et en août de 2013 et de 2014, soit avant et après la mise sur pied du SIEP. Ont fait l’objet de comparaison les trois principales variables relevées durant les deux périodes indiquées. Des analyses de sous-groupes ont aussi été faites pour chacun des niveaux (1 à 5) de l’Échelle canadienne de triage et de gravité (ECTG), séparément ainsi que pour le seul groupe de malades hospitalisés.

Résultats

Une augmentation importante du DA de 5 minutes (p=0,036) et de la DS de 10 minutes (p=0,001) ainsi qu’une augmentation de la proportion de patients partis sans avoir vu de médecin, qui est passée 7,2% à 8,1% (p=0,002), ont été observées après la mise sur pied du SIEP. La DS des malades hospitalisés a augmenté de 63 minutes (p<0,001), le DA des patients appartenant aux niveaux 3 ou 5 selon l’ECTG a augmenté de 6 minutes (p=0,001) et de 39 minutes (p=0,005), et la proportion de patients qui sont partis sans avoir vu de médecin a augmenté considérablement chez les patients appartenant aux niveaux 3 à 5 selon l’ECTG, et notamment chez ceux du niveau 5, qui est passée de 24,3% à 42,0% (p<0,001).

Conclusions

La mise sur pied du SIEP s’est répercutée défavorablement sur toutes les mesures de roulement des patients qui ont été examinées. Le résultat le plus manifeste sur le plan clinique est l’augmentation de la DS de 63 minutes chez les malades hospitalisés. Alors, il y a lieu de se poser la question de savoir si les effets potentiellement néfastes de la mise sur pied du SIEP à l’égard de la sécurité des patients dépassent les avantages.

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Copyright
Corresponding author
Correspondence to: Dr. Andrew Gray, 1810 Blackwater Road, London, ON N5X 4J4; Email: agray6@gmail.com
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Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
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