Computerized Provider Order Entry Reduces Length of Stay in a Community Hospital

Abstract

KeywordsComputerized physician order entry system, CPOE, length of stay, meaningful use, HITECH Act SummaryObjective: 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 HITECH incentives, using a vendor product in a community hospital. Methods: The methodology retrospectively evaluated correlation between CPOE and LOS on a perpatient, 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 organized 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 decreased 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. Background and ObjectivesOver the past three decades, financial constraints, scarce resources, patient preferences, and the regulatory environment exerted significant pressure on hospitals to reduce hospital length of stay (LOS) [1]. Bundled payments, along with prospective and retrospective payment reductions, as examples, have encouraged or incentivized more efficient processes and approaches to patient care [2][3]. Hospitals have responded by instituting numerous strategies to shorten patient stays, including leveraging capabilities associated with electronic medical records (EMRs) as well as relying on traditional human-dependent improvements [4][5]. Recent federal incentives legislated in the HI-TECH act [6] accelerated efforts to implement EMRs. A key component of certified EMRs is computerized provider order entry (CPOE). The current investigation asks if CPOE favorably affects LOS which represents a readily available composite proxy metric for clinical, cost, and efficiency outcomes.At least six studies [7][8][9][10][11][12] suggest CPOE can contribute to shortened LOS. Five of these...