Subscribe to RSS
Computerized Provider Order Entry with Pager Notification Improves Efficiency in STAT Radiographic Studies and Respiratory Treatments
20 October 2009
accepted after major revision: 02 February 2010
16 December 2017 (online)
Background: The use of computerized provider order entry (CPOE) has been widely linked to improvements in patient safety. We hypothesized that electronic routing of CPOE-generated orders through individual pagers would improve the efficiency of STAT radiographic studies and respiratory treatments.
Methods: The study was conducted in two periods before and after implementing pager notification of STAT orders. In the Baseline Period, CPOE-generated STAT orders were communicated to radiology technicians or respiratory therapists through the use of printed orders, manual paging and/or telephone communication. The time to process the order and deliver a radiology result or respiratory treatment was tracked. In the Intervention Period CPOE-generated STAT orders were electronically routed to the radiology technician’s or respiratory therapist’s pager. During both time periods, clinicians completed user satisfaction surveys.
Results: Using pager notification, there was a significant reduction in radiology technician arrival time (16.8±2.1 vs 7.9±0.7 mins, p<0.001). Similarly there was a significant reduction in the cumulative time required to capture the radiographic image, image availability in the picture archiving and communication system (PACS) and the verbal report from the radiologist (p<0.05). The time required in obtaining a preliminary or final radiographic written report and the total cycle times were not significantly reduced. For STAT respiratory therapy orders there was a significant reduction in the mean time from ordering to administration of respiratory therapy treatments (124.7±14.1 vs 49.8±11.4 minutes, p<0.01). Radiologists, respiratory therapists and ordering clinicians reported improved satisfaction after implementation of pager notification.
Conclusion: Computer-generated orders for STAT radiographic studies and respiratory treatments can be carried out significantly faster through the use of direct pager notification. The implementation of this process has resulted in improved care delivery and widespread clinician satisfaction.
- 1 Kohn L, Corrigan J, Donaldson M. eds. To err is human: building a safer health system.. Washington, DC: National Academy Press,; 1999
- 2 The Leapfrog Group.. Available at http://www.leapfroggroup.org accessed Feb 5, 2010.
- 3 Bates DW, O’Neil AC, Boyle D, Teich J, Chertow GM, Komaroff AL. et al. Potential identifiability and preventability of adverse events using information systems.. J Am Med Inform Assoc. 1994; 1: 404-11.
- 4 Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices.. Arch Intern Med. 2000; 160: 2741-7.
- 5 Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM. et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors.. JAMA 1998; 280: 1311-16.
- 6 Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma’Luf N. et al. The impact of computerized physician order entry on medication error prevention.. J Am Med Inform Assoc. 1999; 6: 313-21.
- 7 Potts AL, Barr FE, Gregory DF, Wright L, Patel NR. Computerized physician order entry and medication errors in a pediatric critical care unit.. Pediatrics. 2004; 113: 59-63.
- 8 Saxena S, Kempf R, Wilcox S.. Critical laboratory value notification: A failure mode effects and criticality analysis.. Joint Commission Journal on Quality and Patient Safety. 2005; 31: 495-506.
- 9 Joint Commission on Accreditation of Healthcare Organizations.. http://www.jointcommission.org. Accessed Feb 5, 2010.
- 10 Likert R. A technique for the measurement of attitudes.. Archives of Psychology 1932; 140: 55-59.
- 11 Hauser GJ, Pollack MM, Sivit CJ, Taylor GA, Bulas DI, Guion CJ. Routine chest radiographs in pediatric intensive care: a prospective study.. Pediatrics 1989; 83: 465-70.
- 12 Xakellis GC. Improving efficiency in a residency training clinic: results from addressing a root cause of inefficiency.. Fam Med 2003; 35: 514-8.
- 13 Wilbright WA, Marier R, Abrams A, Smith L, Tran D, Thriffiley Jr A. , et al. Building a results review system: a critical first step in transitioning from paper medical records.. AMIA Annu Symp Proc. 2005; 3: 819-23.
- 14 Thomas JW, Guire KE, Horvat GG. Is patient length of stay related to quality of care?. Hosp Health Serv Adm 1997; 42: 489-507.
- 15 The Leapfrog Group.. Computer physician order entry (CPOE) fact sheet.. Available at: http://www.leapfroggroup.org/media/file/FactSheet_CPOE.pdf accessed February 5, 2010.
- 16 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et al. Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care.. Ann Intern Med. 2006; 144: E12-E22.
- 17 Kuperman GJ, Teich JM, Tanasijevic MJ, Ma’Luf N, Rittenberg E, Jha A. et al. Improving response to critical laboratory results with automation: Results of a randomized controlled trial.. JAMIA 1999; 6: 512-22.
- 18 Bacon AK, Paix AD, Williamson JA, Webb RK, Chapman MJ. Crisis management during anaesthesia: pneumothorax.. Qual Saf Health Care 2005; 14: e18.
- 19 Fallot A. Respiratory distress.. Pediatr Ann 2005; 34: 885-91.