Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study

Al-Dorzi, Hasan M; Tamim, Hani M; Cherfan, Antoine; Hassan, Mohamad A; Taher, Saadi; Arabi, Yaseen M

doi:10.1186/1472-6947-11-71

BMC Medical Informatics and Decision Making

Table 2 Outcomes of patients in different pre- and post-computerized physician order entry (CPOE) periods with adjusted risk calculated using multivariate logistic regression analysis.

From: Impact of computerized physician order entry (CPOE) system on the outcome of critically ill adult patients: a before-after study

A. Comparisons in the 24 months pre- vs. 12 months post-CPOE implementation
Variable	Pre-CPOE	Post-CPOE	Adjusted OR ^a or β ^b coefficient	95% CI	P-value
ICU mortality, N (%)	382 (23.4)	187 (20.8)	0.98	0.7 - 1.3	0.87
Hospital mortality, N (%)	633 (38.7)	319 (35.5)	1.00	0.8 - 1.3	0.80
Mechanical ventilation duration in days, mean ± SD	7.2 ± 9.8	6.3 ± 10.8	-0.30	-1.3 - 0.7	0.54
ICU LOS in days, mean ± SD	8.0 ± 10.5	8.1 ± 16.9	1.13	-0.2 - 2.5	0.10
Hospital LOS in days, mean ± SD	46.8 ± 77.5	46.6 ± 84.6	3.60	-4.5 - 11.8	0.39
B. Comparisons in the 12 months pre- vs. 12 months post-CPOE implementation
Variable	Pre-CPOE	Post-CPOE	Adjusted OR^a or β^b coefficient	95% CI	P-value
ICU mortality, No.%	190 (23.4)	187 (20.8)	0.96	0.7 - 1.3	0.78
Hospital mortality, No.%	296 (36.4)	319 (35.5)	1.24	0.9 - 1.6	0.13
MV duration, mean ± SD	7.6 ± 10.3	6.3 ± 10.8	-0.56	-1.7 - 0.6	0.35
ICU LOS, mean ± SD	8.4 ± 10.5	8.1 ± 16.9	0.78	-0.9 - 2.5	0.37
Hospital LOS, mean ± SD	44.2 ± 64.5	46.6 ± 84.6	5.04	-4.1 - 14.2	0.28
C. Comparisons in the 3 months pre- vs. 3 months post-CPOE implementation
Variable	Pre-CPOE	Post-CPOE	Adjusted OR^a or β^b coefficient	95% CI	P-value
ICU mortality, N (%)	52 (27.1)	55 (23.0)	0.83	0.5 - 1.5	0.55
Hospital mortality, N (%)	74 (38.5)	90 (37.7)	1.04	0.6 - 1.8	0.90
Mechanical ventilation duration in days, mean ± SD	8.0 ± 9.9	6.1 ± 8.0	-1.49	-3.2 - 0.2	0.09
ICU LOS in days, mean ± SD	9.2 ± 11.2	6.9 ± 8.4	-1.77	-3.6 - 0.1	0.06
Hospital LOS in days, mean ± SD	41.2 ± 53.9	41.1 ± 53.1	1.21	-10.4 - 12.8	0.84
D. Comparisons in the 1 month pre- vs. 1 month post-CPOE implementation
Variable	Pre-CPOE	Post-CPOE	Adjusted OR^a or β^b coefficient	95% CI	P-value
ICU mortality, N (%)	16 (23.2)	16 (21.3)	1.17	0.4 - 3.2	0.77
Hospital mortality, N (%)	24 (34.8)	28 (37.3)	2.10	0.8 - 5.5	0.14
Mechanical ventilation duration in days, mean ± SD	8.3 ± 9.8	5.8 ± 9.8	-2.74	-5.4 - (-0.1)	0.04
ICU LOS in days, mean ± SD	9.1 ± 10.0	6.5 ± 6.7	-2.52	-5.3 - 0.3	0.08
Hospital LOS in days, mean ± SD	39.0 ± 45.9	41.2 ± 55.1	-1.28	-19.2 - 16.6	0.89

These outcomes include ICU and hospital mortality, duration of mechanical ventilation and length of stay in the hospital and the intensive care unit. Adjustment was done for age, gender, Acute Physiology and Chronic Health Evaluation II score, source of admission, reason for admission (non-operative trauma and post-operative trauma), cardiac arrest as a reason for admission, chronic health illnesses (liver, cardiovascular and renal), creatinine, INR, use of vasopressors, and mechanical ventilation.
ICU: intensive care unit; CPOE: computerized physician order entry; CCRT: continuous renal replacement therapy; OR: odds ratio; CI: confidence interval CPOE: computerized physician order entry, ICU: intensive care unit, LOS: length of stay, SD: standard deviation, APACHE: Acute Physiology and Chronic Health Evaluation
a: OR is reported for categorical outcomes.
b: β coefficient is reported for continuous variables.
*The other variables that remained significant in the stepwise logistic multivariate regression analysis were: male gender (OR 1.39, 95% CI 1.07-1.81), APACHE II (OR 1.09, 95% CI 1.07-1.11), requirement for mechanical ventilation (OR 21.9, 95% CI 7.62-62.94), liver cirrhosis (OR 2.97, 95% CI 2.16-4.10), postoperative trauma (OR 0.38, 95% CI 0.25-0.58) and INR (OR 1.53, 95% CI 1.34-1.76).
**The other variables that remained significant in the stepwise multivariate logistic regression analysis were: age (OR 1.01, 95% CI 1.01-1.02), APACHE II (OR 1.09, 95% CI 1.07-1.11), requirement for mechanical ventilation (OR 2.451, 95% CI 1.67-3.59), liver cirrhosis (OR 2.39, 95% CI 1.72-3.31) chronic renal failure (OR 1.61, 95% CI 1.16-2.22), postoperative trauma (OR 0.43, 95% CI 0.31-0.59), non-operative trauma (OR 0.66, 95% CI 0.44-1.01), INR (OR 1.56, 95% CI 1.34-1.82) and creatinine (OR 1.00, 95% CI 0.99-1.00).

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ISSN: 1472-6947

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