title: Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis of the impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay (LOS), and mortality in intensive care units (ICUs).
  
  
  METHODS
  We searched for English-language literature published between January 2000 and January 2016 using Medline, Embase, and CINAHL. Titles and abstracts of 586 unique citations were screened. Studies were included if they: (1) reported results for an ICU population; (2) evaluated the impact of CPOE or the addition of CDSSs to an existing CPOE system; (3) reported quantitative data on medication errors, ICU LOS, hospital LOS, ICU mortality, and/or hospital mortality; and (4) used a randomized controlled trial or quasi-experimental study design.
  
  
  RESULTS
  Twenty studies met our inclusion criteria. The transition from paper-based ordering to commercial CPOE systems in ICUs was associated with an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. Overall meta-analyses of LOS and hospital mortality did not demonstrate a significant change.
  
  
  CONCLUSIONS
  Critical care settings, both adult and pediatric, involve unique complexities, making them vulnerable to medication errors and adverse patient outcomes. The currently limited evidence base requires research that has sufficient statistical power to identify the true effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of CDSSs can be used to provide greater benefit to delivering safe and effective patient care.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Mirela
authors.initials: M
authors.lastname: Prgomet
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran.|Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Niazkhani
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
mesh_terms: D000328:Adult; D002648:Child; D020000:Decision Support Systems, Clinical; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*
keywords: clinical; decision support systems; length of stay; medical order entry systems; medication errors; mortality