title: Does extended CPOE use reduce patient length of stay?
abstract: This study compares use of Computerized Provider Order Entry (CPOE) and related clinical systems (i.e., extended CPOE) across 796 clinical teams caring for five distinct patient conditions. Our focus is the relationship between clinical teams' extended CPOE use and extent of prolonged stay (EPS), defined as the deviation in patients' observed length of stay from expected risk-adjusted length of stay.
  
  
  
  Using archival data from two affiliated hospitals in the Southeastern United States, we focused on five different patient conditions of varying mortality risk (vaginal birth, knee/hip replacement, cardiovascular surgery, organ transplant and pneumonia). For each patient, we (1) differentiated between the following three types of care team members-Responsible physician, Core team (excluding the responsible physician), and Support team, (2) created a composite of CPOE orders, documentation entries, patient record lookups, order set adherence, alert acknowledgement, and progress note entries to assess the deep structure use (DSU) of CPOE by the three types of members in the patients' care team, and (3) aggregated DSU of CPOE across all three types of care team members to calculate Total team DSU.
  
  
  
  Teams with higher Total team DSU of CPOE had lower EPS for all five patient conditions. Patients of Core teams with higher DSU of CPOE had lower EPS in all conditions except organ transplant, comprising 93% of the patients studied. Higher DSU of CPOE by all three clinician types significantly reduced EPS for vaginal birth and knee/hip replacement, whereas higher DSU by two of the three types of care team members significantly reduced EPS for cardiovascular surgery and pneumonia.
  
  
  
  Our results suggest that a clinician team that uses CPOE in a comprehensive manner is better informed enabling the team to coordinate care more effectively, resulting in reduced EPS.
authors.affiliation: Georgia Gwinnett College School of Business, 1000 University Center Lane, Lawrenceville 30042, Georgia. Electronic address: dromanow1@GGC.edu.
authors.forename: Darryl
authors.initials: D
authors.lastname: Romanow
authors.affiliation: Center for Process Innovation, J. Mack Robinson College of Business, Georgia State University, Atlanta, GA 30303-3083, USA. Electronic address: arunrai@gsu.edu.
authors.forename: Arun
authors.initials: A
authors.lastname: Rai
authors.affiliation: Computer Information Systems Department, J. Mack Robinson College of Business, Georgia State University, Atlanta, GA 30303-3083, USA. Electronic address: mkeil@gsu.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Keil
authors.affiliation: Peachtree Health Informatics, LLC, Atlanta, GA 30305, USA. Electronic address: steven@phi.healthcare.
authors.forename: Steven
authors.initials: S
authors.lastname: Luxenberg
mesh_terms: D016208:Databases, Factual; D006788:Hospitals, Voluntary; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D050316:Medical Order Entry Systems; D010348:Patient Care Team; D015144:Southeastern United States
keywords: CPOE; Deep structure use; Meaningful use; Risk adjusted length of stay