title: Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.
abstract: OBJECTIVE
  In response to the landmark 1999 report by the Institute of Medicine and safety initiatives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physician order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hypothesis that CPOE implementation results in reduced mortality among children who are transported for specialized care.
  
  
  METHODS
  Demographic, clinical, and mortality data were collected of all children who were admitted via interfacility transport to our regional, academic, tertiary-care level children's hospital during an 18-month period. A commercially sold CPOE program that operated within the framework of a general, medical-surgical clinical application platform was rapidly implemented hospital-wide over 6 days during this period. Retrospective analyses of pre-CPOE and post-CPOE implementation time periods (13 months before and 5 months after CPOE implementation) were subsequently performed.
  
  
  RESULTS
  Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94-5.55) after adjustment for other mortality covariables.
  
  
  CONCLUSIONS
  We have observed an unexpected increase in mortality coincident with CPOE implementation. Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when implementing CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies.
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. yyhan@med.umich.edu
authors.forename: Yong Y
authors.initials: YY
authors.lastname: Han
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carcillo
authors.forename: Shekhar T
authors.initials: ST
authors.lastname: Venkataraman
authors.forename: Robert S B
authors.initials: RS
authors.lastname: Clark
authors.forename: R Scott
authors.initials: RS
authors.lastname: Watson
authors.forename: Trung C
authors.initials: TC
authors.lastname: Nguyen
authors.forename: Hülya
authors.initials: H
authors.lastname: Bayir
authors.forename: Richard A
authors.initials: RA
authors.lastname: Orr
mesh_terms: D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008297:Male; D050316:Medical Order Entry Systems; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer