title: Impact of computerized provider order entry (CPOE) on length of stay and mortality.
abstract: To examine changes in patient outcome variables, length of stay (LOS), and mortality after implementation of computerized provider order entry (CPOE).
  
  
  
  A 5-year retrospective pre-post study evaluated 66 186 patients and 104 153 admissions (49 683 pre-CPOE, 54 470 post-CPOE) at an academic medical center. Generalized linear mixed statistical tests controlled for 17 potential confounders with 2 models per outcome.
  
  
  
  After controlling for covariates, CPOE remained a significant statistical predictor of decreased LOS and mortality. LOS decreased by 0.90 days, P  < .0001. Mortality decrease varied by model: 1 death per 1000 admissions (pre = 0.006, post = 0.0005, P  < .001) or 3 deaths (pre = 0.008, post = 0.005, P  < .01). Mortality and LOS decreased in medical and surgical units but increased in intensive care units.
  
  
  
  This study examined CPOE at multiple levels. Given the inability to randomize CPOE assignment, these results may only be applicable to the local setting. Temporal trends found in this study suggest that hospital-wide implementations may have impacted nursing staff and new residents. Differences in the results were noted at the patient care unit and room levels. These differences may partly explain the mixed results from previous studies.
  
  
  
  Controlling for confounders, CPOE implementation remained a statistically significant predictor of LOS and mortality at this site. Mortality appears to be a sensitive outcome indicator with regard to hospital-wide implementations and should be further studied.
authors.affiliation: Hospital Information Technology Services, Enterprise Data Warehouse, University of Utah Hospital and Clinics, Salt Lake City, UT, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Lyons
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Sward
authors.affiliation: Hospital Information Technology Services, Enterprise Data Warehouse, University of Utah Hospital and Clinics, Salt Lake City, UT, USA.
authors.forename: Vikrant G
authors.initials: VG
authors.lastname: Deshmukh
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, USA.
authors.forename: Marjorie A
authors.initials: MA
authors.lastname: Pett
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Donaldson
authors.affiliation: Hospital Information Technology Services, Enterprise Data Warehouse, University of Utah Hospital and Clinics, Salt Lake City, UT, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Turnbull
mesh_terms: D000046:Academic Medical Centers; D057286:Electronic Health Records; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D050316:Medical Order Entry Systems; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
keywords: CPOE; electronic health records; health services research; length of stay; mortality (death rate)