title: Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system.
abstract: BACKGROUND
  A computerized physician order entry (CPOE) system with embedded clinical decision support can reduce medication errors in hospitals, but might increase the time taken to generate orders.
  
  
  OBJECTIVE
  We aimed to quantify the effects of temporal (month, day of week, hour of shift) and other factors (grade of doctor, prior experience with the system, alert characteristics, and shift type) on the time taken to generate a prescription order.
  
  
  METHODS
  A large university teaching hospital using a locally developed CPOE system with an extensive audit database.
  
  
  METHODS
  We retrospectively analyzed prescription orders from the audit database between August 2011 and July 2012.
  
  
  RESULTS
  The geometric mean time taken to generate a prescription order within the CPOE system was 11.75 s (95% CI 11.72 to 11.78). Time to prescribe was most affected by the display of high-level (24.59 s (24.43 to 24.76); p<0.001) or previously unseen (18.87 s (18.78 to 18.96); p<0.001) alerts. Prescribers took significantly less time at weekends (11.29 s (11.23 to 11.35)) than on weekdays (11.88 s (11.84 to 11.91); p<0.001), in the first (11.25 s (11.16 to 11.34); p<0.001) and final (11.56 s (11.47 to 11.66); p<0.001) hour of their shifts, and after the first month of using the system.
  
  
  CONCLUSIONS
  The display of alerts, prescribing experience, system familiarity, and environment all affect the time taken to generate a prescription order. Our study reinforces the need for appropriate alerts to be presented to individuals at an appropriate place in the workflow, in order to improve prescribing efficiency.
authors: College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors: Jamie J
authors: JJ
authors: Coleman
authors: University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors: James
authors: J
authors: Hodson
authors: College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors: Sarah K
authors: SK
authors: Thomas
authors: University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors: Hannah L
authors: HL
authors: Brooks
authors: College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors: Robin E
authors: RE
authors: Ferner
mesh_terms: D020000:Decision Support Systems, Clinical; D004360:Drug Therapy, Computer-Assisted; D055695:Electronic Prescribing; D006785:Hospitals, University; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom
keywords: Decision Support Systems, Clinical; Electronic Prescribing; Medication errors; Order Entry Systems; Temporal factors