Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric population

Adam B. Keene, Lori Ashton, David Shure, Dorrie Napoleone, Chhavi Katyal, Eran Y. Bellin

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

OBJECTIVE: A worrisome increase in mortality has been reported recently following the initiation of a computerized physician order entry (CPOE) system in a critically ill pediatric transport population. We tested the hypothesis that such a mortality increase did not occur after the initiation of CPOE in a pediatric population that was directly admitted to the neonatal and pediatric intensive care units at Montefiore Medical Center during two 6-month periods before CPOE and one 6-month period immediately after CPOE was initiated. Mortality in the pre- and post-CPOE time periods was compared, and adjustment for potentially confounding covariates was performed. SETTING: The pediatric and neonatal intensive care units at Montefiore Medical Center. PATIENTS: All patients admitted from the emergency room or operating room or as transfers from other institutions directly to the pediatric and neonatal intensive care units at Montefiore Medical Center. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, 29 (3.16%) of the 917 patients in the pre-CPOE period and nine (2.41%) of the 374 patients in the post-CPOE period died during their hospital stay (p = .466). The power to detect the hypothesized mortality increase was 81.7%. The variables that remained significant risk factors for mortality after adjustment were shock (odds ratio, 9.41; 95% confidence interval, 2.90-30.49), prematurity (odds ratio, 3.57; 95% confidence interval, 1.74-7.30), male gender (odds ratio, 3.31; 95% confidence interval, 1.47-7.69), or a hematologic/oncologic diagnosis (odds ratio, 3.14; 95% confidence interval, 1.44-6.86). Post-CPOE initiation status remained unassociated with mortality after adjusting for all covariates (odds ratio, 0.71; 95% confidence interval, 0.32-1.57). CONCLUSION: Mortality did not increase during CPOE initiation.

Original languageEnglish (US)
Pages (from-to)268-271
Number of pages4
JournalPediatric Critical Care Medicine
Volume8
Issue number3
DOIs
StatePublished - May 2007

Fingerprint

Medical Order Entry Systems
Critical Illness
Pediatrics
Mortality
Population
Odds Ratio
Pediatric Intensive Care Units
Confidence Intervals
Neonatal Intensive Care Units
Operating Rooms
Hospital Emergency Service
Shock
Length of Stay

Keywords

  • Computerized physician order entry
  • Mortality
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric population. / Keene, Adam B.; Ashton, Lori; Shure, David; Napoleone, Dorrie; Katyal, Chhavi; Bellin, Eran Y.

In: Pediatric Critical Care Medicine, Vol. 8, No. 3, 05.2007, p. 268-271.

Research output: Contribution to journalArticle

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AU - Bellin, Eran Y.

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N2 - OBJECTIVE: A worrisome increase in mortality has been reported recently following the initiation of a computerized physician order entry (CPOE) system in a critically ill pediatric transport population. We tested the hypothesis that such a mortality increase did not occur after the initiation of CPOE in a pediatric population that was directly admitted to the neonatal and pediatric intensive care units at Montefiore Medical Center during two 6-month periods before CPOE and one 6-month period immediately after CPOE was initiated. Mortality in the pre- and post-CPOE time periods was compared, and adjustment for potentially confounding covariates was performed. SETTING: The pediatric and neonatal intensive care units at Montefiore Medical Center. PATIENTS: All patients admitted from the emergency room or operating room or as transfers from other institutions directly to the pediatric and neonatal intensive care units at Montefiore Medical Center. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, 29 (3.16%) of the 917 patients in the pre-CPOE period and nine (2.41%) of the 374 patients in the post-CPOE period died during their hospital stay (p = .466). The power to detect the hypothesized mortality increase was 81.7%. The variables that remained significant risk factors for mortality after adjustment were shock (odds ratio, 9.41; 95% confidence interval, 2.90-30.49), prematurity (odds ratio, 3.57; 95% confidence interval, 1.74-7.30), male gender (odds ratio, 3.31; 95% confidence interval, 1.47-7.69), or a hematologic/oncologic diagnosis (odds ratio, 3.14; 95% confidence interval, 1.44-6.86). Post-CPOE initiation status remained unassociated with mortality after adjusting for all covariates (odds ratio, 0.71; 95% confidence interval, 0.32-1.57). CONCLUSION: Mortality did not increase during CPOE initiation.

AB - OBJECTIVE: A worrisome increase in mortality has been reported recently following the initiation of a computerized physician order entry (CPOE) system in a critically ill pediatric transport population. We tested the hypothesis that such a mortality increase did not occur after the initiation of CPOE in a pediatric population that was directly admitted to the neonatal and pediatric intensive care units at Montefiore Medical Center during two 6-month periods before CPOE and one 6-month period immediately after CPOE was initiated. Mortality in the pre- and post-CPOE time periods was compared, and adjustment for potentially confounding covariates was performed. SETTING: The pediatric and neonatal intensive care units at Montefiore Medical Center. PATIENTS: All patients admitted from the emergency room or operating room or as transfers from other institutions directly to the pediatric and neonatal intensive care units at Montefiore Medical Center. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, 29 (3.16%) of the 917 patients in the pre-CPOE period and nine (2.41%) of the 374 patients in the post-CPOE period died during their hospital stay (p = .466). The power to detect the hypothesized mortality increase was 81.7%. The variables that remained significant risk factors for mortality after adjustment were shock (odds ratio, 9.41; 95% confidence interval, 2.90-30.49), prematurity (odds ratio, 3.57; 95% confidence interval, 1.74-7.30), male gender (odds ratio, 3.31; 95% confidence interval, 1.47-7.69), or a hematologic/oncologic diagnosis (odds ratio, 3.14; 95% confidence interval, 1.44-6.86). Post-CPOE initiation status remained unassociated with mortality after adjusting for all covariates (odds ratio, 0.71; 95% confidence interval, 0.32-1.57). CONCLUSION: Mortality did not increase during CPOE initiation.

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