麻豆果冻传媒

For Release: May 02, 2010

STANFORD Calif.听鈥� Researchers at Lucile Packard Children鈥檚 Hospital Stanford and Stanford University School of Medicine have shown for the first time that a significant decrease in hospital-wide mortality rates can be associated with implementation of a computerized physician order entry system.

The system, launched at Packard Children鈥檚 in 2007, was correlated with a 20 percent decrease in mortality rates at the hospital over an 18-month period, according to a new study to be published online May 3 in Pediatrics. Researchers noted that other patient care initiatives at the hospital may also have contributed to this important change. With CPOE, doctors and other medical staff can prescribe medications, tests and other treatments electronically, making the instructions instantly and remotely available to all authorized hospital staff, even when off-site. CPOE is part of the hospital鈥檚 electronic medical record, which also provides on screen the latest images and test results. All physicians need to do is boot up a computer, punch in a password and the heartbeat of a child in the neonatal intensive care unit will trace across the screen, or a brain scan can be viewed.

The study arrives as a debate rages over the benefits of CPOE and electronic medical records. While many proponents, including the Obama administration, see these new technologies as critical to improving the quality of our health-care system, critics contend their value has yet to be proven, particularly as some past research has shown negative consequences, including one site that witnessed an increase in mortality. 鈥淧rior to our report, no hospital or medical institution has shown that CPOE can be implemented and actually have an associated decline in mortality,鈥� said lead author听Christopher Longhurst, MD, medical director of clinical informatics at Packard Children鈥檚 and assistant clinical professor of pediatrics at Stanford. 鈥淏ut what we found is that CPOE implementation was statistically correlated with fewer patient deaths. As you can imagine, this is very meaningful.鈥� Longhurst was part of a team of eight researchers from Packard Children鈥檚, Stanford and Harvard University involved in the study. Mark Del Beccaro, MD, a pediatrics professor and vice chair for clinical affairs at Seattle Children's Hospital, who was not involved in this study, said he welcomed the new findings. Seattle Children鈥檚 Hospital implemented CPOE in 2003. 鈥淭hree years later a study of the effects showed mortality rates at our institution held steady,鈥� Del Beccaro said. 鈥淎s the evolution and maturity of these systems and their benefits are being realized, there has been soft evidence that they improve patient safety. The Packard Children鈥檚 report is the first I am aware of to show that you can potentially affect mortality by putting CPOE in place. This is an important study, and we hope others can realize these benefits.鈥�

Longhurst emphasized that the new results show a correlation, not a cause and effect. 鈥淥ur implementation of CPOE was executed superbly, but in addition, we were simultaneously making other advances in patient care,鈥� he said. 鈥淭hese included process and workflow changes, adjustments in ICU staffing, the rollout of Rapid Response Teams, the implementation of a nursing residency and more, all in the face of rising acuity in the hospital.鈥� To determine if a change in mortality rates occurred, Longhurst and his colleagues reviewed nearly 100,000 discharges from Packard Children鈥檚 from Jan. 1, 2001, through April 30, 2009. They compared the observed mortality with the expected mortality, which was generated from a database of 42 tertiary-care, not-for-profit pediatric hospitals similar to Packard Children鈥檚. The result of their analysis was a finding of two fewer deaths per 1,000 discharges at Packard Children鈥檚 in the period after CPOE was implemented, a total of 36 lives over 18 months.

There are many ways CPOE can have a lifesaving impact. With CPOE, crucial data and suggestions that can help guide clinical decisions pop up on the screen as the doctor types in orders and other information about the patient. There will be, for instance, a friendly electronic nudge if a dosing calculation appears to be in error. And it can improve efficiency. 鈥淲e鈥檝e seen a 20 percent improvement in the time from order to administration for 鈥榮tat鈥� [immediate] medications,鈥� noted Longhurst. 鈥淭his can have lifesaving consequences.鈥�

Still, it鈥檚 important to remember that CPOE, and electronic medical records in general, are simply technology tools that support or 鈥渉ard-wire鈥� best practices into the work environment. 鈥淪imply purchasing a fancy and expensive electronic medical records system in and of itself is not likely to make much of a positive impact on quality or patient safety,鈥� said听Paul Sharek, MD, MPH, medical director of quality management and chief clinical patient safety officer at Packard Children's. 鈥淲hat provides the real opportunities for improving care is using this technology to support best practice, such as displaying relevant blood test results at the time physicians are ordering medications, or allowing practice guidelines to be immediately available to physicians at the time of order entry.鈥� Sharek, who is an assistant professor of pediatrics at the medical school, is the study鈥檚 senior author.

Longhurst concluded: 鈥淲e believe our experience is proof that CPOE is here to stay. However, to be successful, it takes an unwavering commitment to implementation. Our staff was very supportive, seeing it as a critical part of a hospital-wide commitment to continuous improvement in patient care. This approach gave us a better chance to determine if CPOE really has an impact in a hospital setting.鈥� Other Stanford/Packard Children鈥檚 authors on the study are Christopher Dawes, MBA, the hospital鈥檚 president and chief executive officer; Jill Sullivan, RN, MSN, vice president of hospital transformation;听Christy Sandborg, MD, professor of pediatric rheumatology and the hospital鈥檚 chief of staff;听Jin Hahn, MD, professor of pediatric neurology; and Eric Widen, MHA, administrative director of performance improvement at the hospital.

Authors

Robert Dicks
(650) 497-8364
rdicks@stanfordchildrens.org