title: Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study.
abstract: BACKGROUND
  Computerized physician order entry (CPOE) systems are recommended to improve patient safety and outcomes. However, their effectiveness has been questioned. Our objective was to evaluate the impact of CPOE implementation on the outcome of critically ill patients.
  
  
  METHODS
  This was an observational before-after study carried out in a 21-bed medical and surgical intensive care unit (ICU) of a tertiary care center. It included all patients admitted to the ICU in the 24 months pre- and 12 months post-CPOE (Misys®) implementation. Data were extracted from a prospectively collected ICU database and included: demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, admission diagnosis and comorbid conditions. Outcomes compared in different pre- and post-CPOE periods included: ICU and hospital mortality, duration of mechanical ventilation, and ICU and hospital length of stay. These outcomes were also compared in selected high risk subgroups of patients (age 12-17 years, traumatic brain injury, admission diagnosis of sepsis and admission APACHE II > 23). Multivariate analysis was used to adjust for imbalances in baseline characteristics and selected clinically relevant variables.
  
  
  RESULTS
  There were 1638 and 898 patients admitted to the ICU in the specified pre- and post-CPOE periods, respectively (age = 52 ± 22 vs. 52 ± 21 years, p = 0.74; APACHE II = 24 ± 9 vs. 24 ± 10, p = 0.83). During these periods, there were no differences in ICU (adjusted odds ratio (aOR) 0.98, 95% confidence interval [CI] 0.7-1.3) and in hospital mortality (aOR 1.00, 95% CI 0.8-1.3). CPOE implementation was associated with similar duration of mechanical ventilation and of stay in the ICU and hospital. There was no increased mortality or stay in the high risk subgroups after CPOE implementation.
  
  
  CONCLUSIONS
  The implementation of CPOE in an adult medical surgical ICU resulted in no improvement in patient outcomes in the immediate phase and up to 12 months after implementation.
authors.affiliation: King Abdulaziz Medical City, Riyadh, 11426, Saudi Arabia.
authors.forename: Hasan M
authors.initials: HM
authors.lastname: Al-Dorzi
authors.forename: Hani M
authors.initials: HM
authors.lastname: Tamim
authors.forename: Antoine
authors.initials: A
authors.lastname: Cherfan
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Hassan
authors.forename: Saadi
authors.initials: S
authors.lastname: Taher
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D016638:Critical Illness / Q000628:therapy*; D020000:Decision Support Systems, Clinical; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010343:Patient Admission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D012121:Respiration, Artificial; D012529:Saudi Arabia; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy
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