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Does extended CPOE use reduce patient length of stay?

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Title: Does extended CPOE use reduce patient length of stay?
Authors: Romanow, Darryl1 dromanow1@GGC.edu, Rai, Arun2 arunrai@gsu.edu, Keil, Mark3 mkeil@gsu.edu, Luxenberg, Steven4 steven@phi.healthcare
Source: International Journal of Medical Informatics. Jan2017, Vol. 97, p128-138. 11p.
Subjects: Deep structure (Linguistics), Cardiovascular surgery, Medical care, Hospitals, Medical informatics periodicals, Databases, Health care teams, Length of stay in hospitals
Geographic Terms: United States, Southern States
Abstract: Objective: 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.Materials and Methods: 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.Results: 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.Conclusions: 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. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Medical Informatics is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Engineering Source
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Header DbId: egs
DbLabel: Engineering Source
An: 119966140
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
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  Data: Does extended CPOE use reduce patient length of stay?
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  Data: <searchLink fieldCode="AR" term="%22Romanow%2C+Darryl%22">Romanow, Darryl</searchLink><relatesTo>1</relatesTo><i> dromanow1@GGC.edu</i><br /><searchLink fieldCode="AR" term="%22Rai%2C+Arun%22">Rai, Arun</searchLink><relatesTo>2</relatesTo><i> arunrai@gsu.edu</i><br /><searchLink fieldCode="AR" term="%22Keil%2C+Mark%22">Keil, Mark</searchLink><relatesTo>3</relatesTo><i> mkeil@gsu.edu</i><br /><searchLink fieldCode="AR" term="%22Luxenberg%2C+Steven%22">Luxenberg, Steven</searchLink><relatesTo>4</relatesTo><i> steven@phi.healthcare</i>
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  Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Medical+Informatics%22">International Journal of Medical Informatics</searchLink>. Jan2017, Vol. 97, p128-138. 11p.
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  Data: <searchLink fieldCode="DE" term="%22Deep+structure+%28Linguistics%29%22">Deep structure (Linguistics)</searchLink><br /><searchLink fieldCode="DE" term="%22Cardiovascular+surgery%22">Cardiovascular surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care%22">Medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Hospitals%22">Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+informatics+periodicals%22">Medical informatics periodicals</searchLink><br /><searchLink fieldCode="DE" term="%22Databases%22">Databases</searchLink><br /><searchLink fieldCode="DE" term="%22Health+care+teams%22">Health care teams</searchLink><br /><searchLink fieldCode="DE" term="%22Length+of+stay+in+hospitals%22">Length of stay in hospitals</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink><br /><searchLink fieldCode="DE" term="%22Southern+States%22">Southern States</searchLink>
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  Data: <bold>Objective: </bold>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.<bold>Materials and Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of International Journal of Medical Informatics is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1016/j.ijmedinf.2016.09.012
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      – Code: eng
        Text: English
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        PageCount: 11
        StartPage: 128
    Subjects:
      – SubjectFull: Deep structure (Linguistics)
        Type: general
      – SubjectFull: Cardiovascular surgery
        Type: general
      – SubjectFull: Medical care
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      – SubjectFull: Hospitals
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      – SubjectFull: Medical informatics periodicals
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      – SubjectFull: Databases
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      – SubjectFull: Health care teams
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      – SubjectFull: Length of stay in hospitals
        Type: general
      – SubjectFull: United States
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      – SubjectFull: Southern States
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      – TitleFull: Does extended CPOE use reduce patient length of stay?
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              Text: Jan2017
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              Y: 2017
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