title: Electronic Ordering System Improves Postoperative Pain Management After Total Knee or Hip Arthroplasty.
abstract: OBJECTIVE
  The authors investigated the impact of computerized provider order entry (CPOE) on the delivery times of analgesia and subsequent patient outcomes. We hypothesized that patients would report less pain and use less pain medications compared with the previous paper-based system.
  
  
  METHODS
  Two groups of patients after a total hip (THA) or knee arthroplasty (TKA) were retrospectively compared: one comprising 106 patients when the paper-based ordering system was in effect (conventional group), and one comprising 96 patients after CPOE was installed (electronic group). All patients received a regional anaesthetic at surgery (combined spinal-epidural). TKA patients also received a single-injection femoral nerve block. After transfer to the postoperative anaesthesia care unit (PACU), a patient-controlled epidural analgesia (PCEA) infusion was initiated. The following data was collected from the PACU record: time to initiation of analgesia, visual analog scale (VAS) pain scores at initiation of analgesia and hourly for the first postoperative day (POD), volume of pain medication used, length of stay (LOS) in the PACU and the hospital.
  
  
  RESULTS
  The time to initiation of analgesia from arrival in the PACU was significantly lower in the electronic group compared to the conventional group (24.5 ± 28.3 minutes vs. 51.1 ± 26.2 minutes; mean ± SD, p < 0.001), as were VAS pain scores (0.82 ± 1.08 vs. 1.5 ± 1.52, p < 0.001) and the volume of PCEA needed to control pain (27.9 ± 20.2 ml vs. 34.8 ± 20.3 ml, p = 0.001) at 4 hours postoperatively. PACU LOS and hospital LOS did not significantly differ in the two groups.
  
  
  CONCLUSIONS
  After implementation of CPOE, patients received their postoperative analgesia faster, had less pain, and required less medication.
authors.affiliation: Hospital for Special Surgery, Anesthesiology , New York, NY, United States.
authors.forename: M K
authors.initials: MK
authors.lastname: Urban
authors.affiliation: Hospital for Special Surgery, Quality Research Center , Auckland, New Zealand.
authors.forename: T
authors.initials: T
authors.lastname: Chiu
authors.affiliation: Hospital for Special Surgery, Quality Research Center , New York, NY, United States.
authors.forename: S
authors.initials: S
authors.lastname: Wolfe
authors.affiliation: Hospital for Special Surgery, Quality Research Center , New York, NY, United States.
authors.forename: S
authors.initials: S
authors.lastname: Magid
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D050316:Medical Order Entry Systems; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D057188:Workflow
chemical_list: D000700:Analgesics
keywords: Patient controlled anesthesia (PCA); arthroplasty; computerized physician order entry (CPOE); electronic health records and systems; medication management