4. Computerized Physician Order Entry in the Emergency Department

6. Can CPOE make me safer? Mortality Medication errors

7. Mortality

8. Medication Errors

9. StudyDecrease in Medication Error Comments Bates et al, 199981%Typical medications: antibiotics analgesics anticoagulants electrolytes Bates et al, 199857% Sard et al, 200890% Aronsky et al, 200791% King et al, 200340%CHEO (SCM) Upperman et al, 2005Avoid 1 ADE q20dPre-post differences Holdsworth et al, 2007Avoid 1 ADE q64dVery small numbers

10. Can CPOE make me safer? Very limited ED data Mortality Medication Errors

11. Can CPOE make me smarter?

19. Inpatient Evidence

20. StudyNo CDSCDSP Value Evans et al, 199477%94%<0.001 Paul et al, 2006 Concurrent RCT 57% 64% 70% 73% <0.001 0.03

21. ED Evidence

27. CharacteristicPre-CPOEPost-CPOEP Value Presence of a clinical question34.8%52.6%<0.0001 Information on prior diagnoses51.1%71.1%<0.01 Length (characters)49.671.2<0.05

28. Can CPOE make me smarter? CDS functionality Abx Renal dosing Medications in older patients Improved communication to radiology

29. Can CPOE make me faster? NO

30. Inpatient Evidence

31. Outpatient Evidence CPOE Paper

32. ED Evidence ActivityTime Pre-CPOETime Post-CPOEP Value Staff order entry5 min9.5 min0.01 Resident order entry5.5 min14.3 min0.001 RN-staff communication24.5 min13.3 min0.01

33. Can CPOE make me faster? Not looking good… Inpatient data Outpatient data ED data

34. Can CPOE improve ED flow? CharacteristicPre-EMR/CPOE TimePost-EMR/CPOE TmePre-Post Difference ED LOS6.69 hrs4.75 hrs116 min Lab turnaround time2.03 hrs1.44 hrs35 min X-ray turnaround time55 min44 min11 min CT turnaround time3.64 hrs1.74 hrs114 min

35. Investigation Turnaround Times StudyTest Turnaround Time (min)Difference (min) Pre-CPOEPost-CPOE Guss et al, 2008 Na CBC TnI 46.7 42.2 41.8 37.2 36.3 30.6 9.5 5.9 11.2 Westbrook et al, 2008352510 Westbrook et al, 200673.858.315.5

36. Investigation Turnaround Times

37. ED Length of Stay

38. Can CPOE improve ED flow? Not enough solid data on ED LOS Potential to improve test turnaround time

39. ✗ ✓ ? ✓ ✗ ✓ ? ✗