title: Computerized physician order entry and decision support improves ED analgesic ordering for renal colic.
abstract: OBJECTIVE
  Computerized physician order entry (CPOE) offers the potential for safer, faster patient care, as well as greater use of evidence-based therapy via built-in decision support. However, the effectiveness of CPOE in yielding these benefits has shown mixed results in the emergency department (ED) setting. Our objective was to evaluate the impact of CPOE implementation on analgesic prescribing and dosing practices for renal colic presentations.
  
  
  METHODS
  This retrospective pre/post comparative study was conducted in 3 tertiary hospitals that implemented CPOE in 2010. Two patient groups were compared: prior to (pre-CPOE) and after (post-CPOE) CPOE implementation. Each group consisted of 230 randomly selected, high-acuity patients presenting to the ED with renal colic. The primary outcome was the proportion of patients receiving ketorolac in the ED. Secondary outcomes included choice of analgesic and average morphine dose.
  
  
  RESULTS
  The proportion of patients receiving ketorolac significantly increased after CPOE implementation (65.6% pre-CPOE vs 76.5% post-CPOE, P = .015), as did the proportion of patients receiving fentanyl (pre, 9.7%; post, 16.7%; P = .047). Differences in morphine use (pre, 66.0%; post, 69.1%) and average morphine dose (pre, 10.09 mg; post, 12.28 mg) did not reach statistical significance.
  
  
  CONCLUSIONS
  The introduction of CPOE is associated with an increase in ketorolac use for ED renal colic visits. This may reflect the inclusion of ketorolac in the renal colic order set. Computerized physician order entry implementation with condition-specific electronic order sets and decision support may improve evidence-based practice.
authors.affiliation: Department of Emergency Medicine, University of Calgary, Calgary, Alberta.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Netherton
authors.affiliation: Department of Emergency Medicine, University of Calgary, Calgary, Alberta.
authors.forename: Kevin
authors.initials: K
authors.lastname: Lonergan
authors.affiliation: Department of Emergency Medicine, University of Calgary, Calgary, Alberta.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, University of Calgary, Calgary, Alberta.
authors.forename: Andrew
authors.initials: A
authors.lastname: McRae
authors.affiliation: Department of Emergency Medicine, University of Calgary, Calgary, Alberta. Electronic address: eddy.lang@albertahealthservices.ca.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D020000:Decision Support Systems, Clinical / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration; D009020:Morphine / Q000627:therapeutic use; D056844:Renal Colic / Q000188:drug therapy*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration
chemical_list: D000700:Analgesics; D009020:Morphine; D005283:Fentanyl; D020910:Ketorolac