RESUMO
Hospital Italiano de Buenos Aires (HIBA) is an academic tertiary care hospital highly specialized that has started the process of informatization of chemotherapy protocols. The objective is to describe the development of a computerized physician order entry (CPOE) oriented to the oncology adult patient and the members of the healthcare team that works with him (physicians, pharmacists, nurses and administrative staf) to improve the process and prevent errors at a critical point in the patient's health care: during prescription, preparation and / or administration. The development of this system consisted of several stages: inquiries about the usual work and perception of needs of the potential users; user-centered design; interoperability with the electronic health record (EHR) and development of a final prototype.
Assuntos
Sistemas de Registro de Ordens Médicas , Adulto , Registros Eletrônicos de Saúde , Hospitais , Humanos , Masculino , Farmacêuticos , MédicosRESUMO
OBJECTIVE: Does computerized provider order entry (CPOE) improve clinical, cost, and efficiency outcomes as quantified in shortened hospital length of stay (LOS)? Most prior studies were done in university settings with home-grown electronic records, and are now 20 years old. This study asked whether CPOE exerts a downward force on LOS in the current era of HITECH incentives, using a vendor product in a community hospital. METHODS: The methodology retrospectively evaluated correlation between CPOE and LOS on a perpatient, per-visit basis over 22 consecutive quarters, organized by discipline. All orders from all areas were eligible, except verbals, and medication orders in the emergency department which were not available via CPOE. These results were compared with quarterly case mix indices organized by discipline. Correlational and regression analyses were cross-checked to ensure validity of R-square coefficients, and data were smoothed for ease of display. Standard models were used to calculate the inflection point. RESULTS: Gains in CPOE adoption occurred iteratively house-wide, and in each discipline. LOS decreased in a sigmoid shaped curve. The inflection point shows that once CPOE adoption approaches 60%, further lowering of LOS accelerates. Overall there was a 20.2% reduction in LOS correlated with adoption of CPOE. Case mix index increased during the study period showing that reductions in LOS occurred despite increased patient complexity and resource utilization. CONCLUSIONS: There was a 20.2% reduction in LOS correlated with rising adoption of CPOE. CPOE contributes to improved clinical, cost, and efficiency outcomes as quantified in reduced LOS, over and above other processes introduced to lower LOS. CPOE enabled a reduction in LOS despite an increase in the case mix index during the time frame of this study.
Assuntos
Eficiência Organizacional/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Uso Significativo/estatística & dados numéricos , Sistemas de Registro de Ordens Médicas/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde , PennsylvaniaRESUMO
INTRODUCTION: The objective of this study was to evaluate whether screening, brief intervention, and referral to treatment (SBIRT) could be incorporated into the emergency nursing workflow using a computerized physician order entry/clinical decision support system. We report demographic and operational factors associated with failure to initiate the protocol and revenue collection from SBIRT. METHODS: We conducted a retrospective, observational cohort analysis of a protocol adding SBIRT to the emergency nursing workflow of a single, tertiary care urban emergency department for all adult patient visits in 2012. Emergency nurses prescreened for unhealthy alcohol or drug use during triage assessment and, when positive, administered SBIRT during treatment area care, all documented in the computerized physician order entry/clinical decision support system. Using multivariable logistic regression, we report demographic and operational factors associated with failure to initiate the protocol. From October 2012, we submitted charges for brief interventions and analyzed collection results. RESULTS: The inclusion criteria were met for 47,693 visits. Of these, 39,758 (83.4%) received triage protocol initiation. Variables associated with decreased odds of protocol initiation were younger age (odds ratio [OR] for rising age, 1.044; 95% confidence interval [CI], 1.042-1.045), arrival by ambulance (OR, 0.37; 95% CI, 0.35-0.40), and higher triage acuity (OR, 0.08; 95% CI, 0.07-0.09). Of visits with protocol initiation, 21.4% were documented as positive for at-risk alcohol and/or drug use. However, brief interventions were only administered during 971 visits. During the billing period, $3617.53 was collected on charges of $10,829.15 for 262 completed brief interventions. DISCUSSION: In this study electronic documentation of adults with at-risk alcohol and/or drug use was feasible by emergency nurses, but SBIRT execution and subsequent revenue collection were challenging.