The effect of computerized provider order entry systems on clinical care and work processes in emergency departments

A systematic review of the quantitative literature

Andrew Georgiou*, Mirela Prgomet, Richard Paoloni, Nerida Creswick, Antonia Hordern, Scott Walter, Johanna Westbrook

*Corresponding author for this work

Research output: Contribution to journalReview article

43 Citations (Scopus)

Abstract

Study objective: We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). Methods: We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. Results: We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre/post design; 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). Conclusion: There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care.

Original languageEnglish
Pages (from-to)644–653.e16
Number of pages26
JournalAnnals of Emergency Medicine
Volume61
Issue number6
DOIs
Publication statusPublished - Jun 2013

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