CPOE is an Independent Risk Factor for Death?

A nice entry from Dr. Andy: Uh oh Computerized Physician Order Entry

Computerized physician order entry (CPOE) is looked on as a panacea which will decrease medical error, improve efficiemcy, and improve patient safety. Only it looks like it has some major, unintended consequences, like increasing death according to an article titled “Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System: in this months Pediatrics.

Anyway, the findings were suprising and alarming:

Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94–5.55) after adjustment for other mortality covariables.

Put in plain English, kids transported after implementation of CPOED has a more than 3 fold increased risk of death. Ouch.

(Emphasis mine). Ouch, indeed.

My response is in the comments of Dr. Andy’s post.


Comments

  1. I believe it. My hospital wants to institute physician order entry. Now instead of taking care of patients and thinking about medical decisions I will be entering orders into a computer?? What will happen to the secretary who does it now that has much better typing skills than I and already knows the order entry system?

  2. One thing we have to keep in mind is that this is a very crude assessment that mainly demands further analysis to firm up the connection between CPOE and this statistic.
    What if someone came up to us and said, “Doctor, we’ve analyzed your practice over the past year and you have had a statistically significant increase in patient deaths.” Would we so readily accept or be able to understand this?

    A potential problem with CPOE is an overreliance on the system to manage things, without paying attention to the still necessary human-human interactions for good patient care.

    There should not by definition be a problem with CPOE, since hospitals have been using computer-entered order systems for quite some time. What we should not accept is that the problem with CPOE is with the “P”(hysician).