Int J Med Inform - Use of order sets in inpatient computerized provider order entry systems: a comparative analysis of usage patterns at seven sites.

Tópicos

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Resumo

CKGROUND: Many computerized provider order entry (CPOE) systems include the ability to create electronic order sets: collections of clinically related orders grouped by purpose. Order sets promise to make CPOE systems more efficient, improve care quality and increase adherence to evidence-based guidelines. However, the development and implementation of order sets can be expensive and time-consuming and limited literature exists about their utilization.METHODS: Based on analysis of order set usage logs from a diverse purposive sample of seven sites with commercially and internally developed inpatient CPOE systems, we developed an original order set classification system. Order sets were categorized across seven non-mutually exclusive axes: admission/discharge/transfer (ADT), perioperative, condition-specific, task-specific, service-specific, convenience, and personal. In addition, 731 unique subtypes were identified within five axes: four in ADT (S=4), three in perioperative, 144 in condition-specific, 513 in task-specific, and 67 in service-specific.RESULTS: Order sets (n=1914) were used a total of 676,142 times at the participating sites during a one-year period. ADT and perioperative order sets accounted for 27.6% and 24.2% of usage respectively. Peripartum/labor, chest pain/acute coronary syndrome/myocardial infarction and diabetes order sets accounted for 51.6% of condition-specific usage. Insulin, angiography/angioplasty and arthroplasty order sets accounted for 19.4% of task-specific usage. Emergency/trauma, obstetrics/gynecology/labor delivery and anesthesia accounted for 32.4% of service-specific usage. Overall, the top 20% of order sets accounted for 90.1% of all usage. Additional salient patterns are identified and described.CONCLUSION: We observed recurrent patterns in order set usage across multiple sites as well as meaningful variations between sites. Vendors and institutional developers should identify high-value order set types through concrete data analysis in order to optimize the resources devoted to development and implementation.

Resumo Limpo

ckground mani computer provid order entri cpoe system includ abil creat electron order set collect clinic relat order group purpos order set promis make cpoe system effici improv care qualiti increas adher evidencebas guidelin howev develop implement order set can expens timeconsum limit literatur exist utilizationmethod base analysi order set usag log divers purpos sampl seven site commerci intern develop inpati cpoe system develop origin order set classif system order set categor across seven nonmutu exclus axe admissiondischargetransf adt periop conditionspecif taskspecif servicespecif conveni person addit uniqu subtyp identifi within five axe four adt s three periop conditionspecif taskspecif servicespecificresult order set n use total time particip site oneyear period adt periop order set account usag respect peripartumlabor chest painacut coronari syndromemyocardi infarct diabet order set account conditionspecif usag insulin angiographyangioplasti arthroplasti order set account taskspecif usag emergencytrauma obstetricsgynecologylabor deliveri anesthesia account servicespecif usag overal top order set account usag addit salient pattern identifi describedconclus observ recurr pattern order set usag across multipl site well meaning variat site vendor institut develop identifi highvalu order set type concret data analysi order optim resourc devot develop implement

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