Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system
Based upon the report by Institute of Medicine and safety initiatives promoted by Leapfrog group, the authors wrote that, Department Critical care Medicine, University of Pittsburg School Of Medicine, Pittsburg, PA, implemented a commercially sold computerized physician order entry (CPOE) systems. Accordingly, the attempt was an effort to reduce medical errors and mortality rate. The idea behind the implementation was to test the hypothesis that CPOE results in the reduction of mortality rate among children who are transported for specialized care. The method employed was, gathering demographic, clinical, and mortality of all children that were admitted via interfacility transport to the authors’ children’s hospital for a period of 18 months. According to the authors, a commercially purchased CPOE was used during the time frame in general and medical-surgical operations. The implementation of the software was completed in six days. Retrospective analysis of pre-CPOE (15 months) and post-CPOE implementation was done on 1942 children.
The authors claimed that 75 children, among the 1942 who were referred for specialized care during the study period, which result in 3.86%. Analysis revealed that the mortality rate increased significantly from 2.80 % (39 of 1394) before the CPOE implementation to 6.57% (36 of 548) after CPOE. With respect to the observations of the authors, they conclude that the unexpected increase in mortality and the implementation of the CPOE seem to be coincidental. Accordingly, while the CPOE holds great promise, the authors advise that, when implementing CPOE, systems, institutions should continue to evaluate mortality effects, in addition to medical error rates for “children who are dependent on time-sensitive therapies.”
Comment: The authors did not totally disagree with the findings of those who were promoting the efficacy of CPOE in clinical settings. It appears that their observations could be prone to errors as well. Moreover, the environment in which the examination was made could not be representative of the total environment in which CPOE systems have been implemented. The unexpected increase in the mortality rate of the patients could also be attributed to the time of the sickness or the degree of illness of the patients involved. Moreover, the authors did not indicate any demonstrable bias against or for the use of CPOE by the clinicians. And this could also be a factor in not using the systems efficiently, which could have had impact on the clinicians’ job performances. Are all these clinicians computer literate? That question was not answered. Therefore, further studies are needed to justify the efficacy of CPOE.
