Computerized Provider Order Entry Reduces Length of Stay in a Community Hospital
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 Health Information Technology Economy and Clinical Health (HITECH) incentives, using a vendor product in a community hospital. Methods: The methodology retrospectively evaluated correlation between CPOE and LOS on a per- patient, 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 organ- ized 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 de- creased 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.
Recently there has been a pressure on hospitals to reduce the length of stay (LOS) of all patients. Numerous strategies have been implemented to reduce LOS, one of which is the reliance on EHRs. Older studies have suggested that CPOE can reduce LOS. This study is trying to investigate if CPOEs contribute to shortened LOS, and if so at what level will CPOE adoption impact on LOS start to accelerate.
The hospital implemented an EMR in august 2007 followed by a CPOE system in February of 2008. The study then collected retrospective data fro 66 consecutive months from July 2007 to December 2012. This data included 76,972 discharges and 6,135,994 orders. The data was then summarized by quarterly LOS and by 19 different disciplines. After summarization, the data was analyzed for correlation and regression of CPOE and LOS.
In 13 of the 19 disciplines studied, there was a statistical correspondence between gains in CPOE and changes in LOS. The overall house sample showed a high statistical significance for a linear regression, and the 13 disciplines that showed a correlation also showed a statistical significance for a linear regression but due to smaller sample sizes the significance was lower. The data also showed a inflection point at 58.31% CPOE adoption rate meaning that the LOS had a significant drop at this time.
This data shows a statistical significance in CPOE adoption verses LOS reduction. Not only does the correlation support the hypothesis, but also the inflection point solidifies how important CPOE adoption truly is. While LOS was reducing before EHR implementation, the rate at which is was reduced by significantly increased during the time that CPOE was introduced. It is also important to note that there was not a large decrease in LOS until the inflection point occurred, further showing that if CPOE is to be adopted it must occur at a high rate.
Increasing CPOE systems in the hospital setting reduces LOS overall and in most of the disciplines studied. And while this studied occurred in a university hospital similar results that occurred during the study should also occur in non-univiersty studies. Overall CPOEs truly do give the return on investment that hospitals are looking for.
Overall, I thought the paper was very intuitive. While I understand that these types of studies must be done to me it seems very logical that an increase in CPOE use will cause a decrease in LOS. Not only does the use of CPOEs give clearer orders, but it will also catch users mistakes before they reach the patient and cause a longer LOS. I would say that it was a good read and that it would be good for other hospital to come together and do the study again so that a larger sample group can be made.
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187086/pdf/ACI-05-0685.pdf Schreiber R. 2014