title: Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system.
abstract: BACKGROUND
  Implementations of computerized physician order entry (CPOE) systems have previously been associated with either an increase or no change in hospital-wide mortality rates of inpatients. Despite widespread enthusiasm for CPOE as a tool to help transform quality and patient safety, no published studies to date have associated CPOE implementation with significant reductions in hospital-wide mortality rates.
  
  
  OBJECTIVE
  The objective of this study was to determine the effect on the hospital-wide mortality rate after implementation of CPOE at an academic children's hospital.
  
  
  METHODS
  We performed a cohort study with historical controls at a 303-bed, freestanding, quaternary care academic children's hospital. All nonobstetric inpatients admitted between January 1, 2001, and April 30, 2009, were included. A total of 80,063 patient discharges were evaluated before the intervention (before November 1, 2007), and 17,432 patient discharges were evaluated after the intervention (on or after November 1, 2007). On November 4, 2007, the hospital implemented locally modified functionality within a commercially sold electronic medical record to support CPOE and electronic nursing documentation.
  
  
  RESULTS
  After CPOE implementation, the mean monthly adjusted mortality rate decreased by 20% (1.008-0.716 deaths per 100 discharges per month unadjusted [95% confidence interval: 0.8%-40%]; P = .03). With observed versus expected mortality-rate estimates, these data suggest that our CPOE implementation could have resulted in 36 fewer deaths over the 18-month postimplementation time frame.
  
  
  CONCLUSIONS
  Implementation of a locally modified, commercially sold CPOE system was associated with a statistically significant reduction in the hospital-wide mortality rate at a quaternary care academic children's hospital.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA. clonghurst@lpch.org
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Longhurst
authors.forename: Layla
authors.initials: L
authors.lastname: Parast
authors.forename: Christy I
authors.initials: CI
authors.lastname: Sandborg
authors.forename: Eric
authors.initials: E
authors.lastname: Widen
authors.forename: Jill
authors.initials: J
authors.lastname: Sullivan
authors.forename: Jin S
authors.initials: JS
authors.lastname: Hahn
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Dawes
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
mesh_terms: D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D016019:Survival Analysis; D017749:Total Quality Management; D014481:United States