Order sets have the potential to provide evidence at the point of care and improve healthcare practice. In this study we reviewed the literature to assess the effect of computerized order sets on practitioner performance. Our search in PubMed and Science direct identified 442 studies of which 16 met our inclusion criteria. In 15 studies order sets contributed to the improvement of at least one performance outcome. The effect of order sets was evaluated on 34 performance outcomes, of which 19 were improved and the rest remained unchanged. The results provide evidence that the use of order sets can improve health care practice

Ahmadian, L

Khajouei, R

Simorgh Research Repository

See	discussions,	stats,	and	author	profiles	for	this	publication	at:	https://www.researchgate.net/publication/230637572Impact	of	computerized	order	sets	onpractitioner	performanceArticle		in		Studies	in	health	technology	and	informatics	·	August	2012DOI:	10.3233/978-1-61499-101-4-1129	·	Source:	PubMedCITATIONS2READS302	authors:Leila	AhmadianKerman	University	of	Medical	Sciences20	PUBLICATIONS			121	CITATIONS			SEE	PROFILEReza	KhajoueiKerman	University	of	Medical	Sciences29	PUBLICATIONS			286	CITATIONS			SEE	PROFILEAll	content	following	this	page	was	uploaded	by	Reza	Khajouei	on	04	September	2014.The	user	has	requested	enhancement	of	the	downloaded	file.	All	in-text	references	underlined	in	blue	are	added	to	the	original	documentand	are	linked	to	publications	on	ResearchGate,	letting	you	access	and	read	them	immediately.Impact of Computerized Order Sets on Practitioner Performance Leila AHMADIANa,1 and Reza KHAJOUEI a a Medical Informatics Research Center, Kerman University of Medical Sciences, Kerman, Iran Abstract: Order sets have the potential to provide evidence at the point of care and improve healthcare practice. In this study we reviewed the literature to assess the effect of computerized order sets on practitioner performance. Our search in PubMed and Science direct identified 442 studies of which 16 met our inclusion criteria. In 15 studies order sets contributed to the improvement of at least one performance outcome. The effect of order sets was evaluated on 34 performance outcomes, of which 19 were improved and the rest remained unchanged. The results provide evidence that the use of order sets can improve health care practice. Keywords: Order set, practitioner performance, CPOE, clinical guideline Introduction Integrating evidences in the treatment process has been one of the challenges for care providers. One solution is the use of order sets. An order set is a group of predefined orders that is used directly by a physician to create orders for a specific patient [1]. Order sets are expected to increase compliance with guidelines. To provide evidence at the point of care many of them are integrated with Computerized Physician Order Entry (CPOE) systems. CPOE systems can reduce error rates [2] and improve performance and adherence to guidelines [3]. However, it is unclear to what extent the improvements are related to integrated order set. Therefore, the main objective of this study is to evaluate the impact of computerized order sets on practitioner performance. 1. Methods We searched PubMed, Science direct, and the reference lists of relevant articles for randomized control trials and comparative studies that assessed the effects of order sets on practitioner performance. Three groups of key terms concerning: (1) computerized systems, (2) evidence-based practice, and (3) order set were used. Operator “OR” is used within groups and the following combinations were applied; (1 OR 2) AND 3. Two reviewers judged titles and abstracts, and inter-observer reliability was assessed by Cohen's kappa. An extraction form was designed based on the literature [4;5] and expert consensus. Two reviewers completed the form for each study. Disagreements concerning study selection and data extraction were resolved through discussion.                                                           1 Corresponding Author: Leila Ahmadian, email: ahmadianle@yahoo.com Quality of Life through Quality of InformationJ. Mantas et al. (Eds.)IOS Press, 2012© 2012 European Federation for Medical Informatics and IOS Press. All rights reserved.doi:10.3233/978-1-61499-101-4-112911292. Results Of 442 retrieved articles, when limiting to comparative and trial studies, 98 articles remained. The review of titles and abstracts left 360 articles. Fourteen studies were identified by full text review and two by the review of reference lists (Cohen’s kappa=0.91). Most studies (69%) reported that the order sets were implemented in CPOE System. In 63% of the studies (n=10) guidelines were used to develop the order sets. Fifteen studies showed an improvement in at least one of the outcomes (Table 1). Compliance with guideline was the most frequently evaluated practitioner performance. Table 1. The effect of computerized order set on practitioner performance Source  Order set  Performance outcomes  Effect*Chan et al [6]  General admission  - Completion time - Number of ordering errors  + 0 Chisolm et al [7]  Asthma admission  - Compliance with evidence-based treatment + Haynes et al [8]  Post operative anti bacterial  - The proportion of discontinued antibacterial wound prophylaxis in the appropriate time frame  + Munasinghe et al [9]  General medicine admission  - The use of order set + Schnipper et al [10]  Diabetes management  - Use of insulin during the hospitalization - Adequacy of basal dose  - Use of scheduled nutritional insulin  - Adequacy of nutritional dose  - Correct type of nutritional insulin - Use of supplemental insulin  - Glycosylated hemoglobin testing  - Clinical inertia 0 0 + 0 0 + 0 0 Asaro et al [11]  Acute coronary syndrome  - The use of order set - Compliance with guideline recommendations  + 0 Ozdas et al [12]  Acute coronary syndrome  - The use of order set for:      Suspected acute myocardial infarction (AMI) - Compliance with guideline for suspected AMI       For early aspirin ordering       For early beta-blocker ordering - Compliance with guideline for confirmed AMI  + 0 + 0 0 Ballard et al [13]  Adult pneumonia  - Compliance with guideline recommendation + Hauck et al [14]  Community-acquired pneumonia  - Performance of blood cultures  - Use of guideline recommended antibiotics + + King et al [15]  Bronchiolitis for children - Frequency of antibiotics ordering  - Frequency of bronchodilators ordering  - Frequency of corticosteroids ordering  + 0 0 Micek et al [16]  Severe sepsis and septic shock - The quantity of administered intravenous fluids - The prescription of appropriate antimicrobial  + + Khajouei et al [1]  Promyelocytic Leukemia - Ordering  efficiency  + Caslin et al  [17] Heart failure - Compliance with guideline recommendation + Chima et al  [18] Diabetes - Tracking patient outcomes  + Shapiro et al  [19] Sepsis treatment - The use of  essential therapies + * + = positive effect and 0= no effect, Number of evaluated practitioner performance=34, improved= 19  3. Discussion This study revealed that use of order set can enhance practitioner performance. The included studies evaluated heterogeneous order sets; from general to disease specific order sets. Similar systematic reviews [2;4;5] did not investigate application of order sets as a factor affecting performance. They showed providing guidelines at the point of care significantly improves patient care and reduces practice variability. One study [11] L. Ahmadian and R. Khajouei / Impact of Computerized Order Sets on Practitioner Performance1130reported that practitioners use order sets to facilitate ordering process rather than using the offered guidance. However, the use of order set showed an improvement in the compliance with guidelines in most studies.  References   [1] Khajouei R, Peek N, Wierenga PC, Kersten MJ, Jaspers MW. Effect of predefined order sets and usability problems on efficiency of computerized medication ordering. Int J Med Inform 2010;79(10):690-8. [2] Ammenwerth E,Schnell-Inderst P,Machan C,Siebert U. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc 2008;15(5):585-600. [3] Georgiou A, Prgomet M, Markewycz A, Adams E, Westbrook JI. The impact of computerized provider order entry systems on medical-imaging services: a systematic review. J Am Med Inform Assoc 2011;18(3):335-40. [4] Ahmadian L, van Engen-Verheul M, Bakhshi-Raiez F, Peek N, Cornet R, de Keizer NF. The role of standardized data and terminological systems in computerized clinical decision support systems: literature review and survey. Int J Med Inform 2011;80(2):81-93. [5] Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005;293(10):1223-38. [6] Chan J, Shojania KG, Easty AC, Etchells EE. Does user-centred design affect the efficiency, usability and safety of CPOE order sets? J Am Med Inform Assoc 2011;18(3):276-81. [7] Chisolm DJ, McAlearney AS, Veneris S, Fisher D, Holtzlander M, McCoy KS. The role of computerized order sets in pediatric inpatient asthma treatment. Pediatr Allergy Immunol 2006;17(3):199-206. [8] Haynes K, Linkin DR, Fishman NO, Bilker WB, Strom BL, Pifer EA, et al. Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period. J Am Med Inform Assoc 2011;18(2):164-8. [9] Munasinghe RL, Arsene C, Abraham TK, Zidan M, Siddique M. Improving the utilization of admission order sets in a computerized physician order entry system by integrating modular disease specific order subsets into a general medicine admission order set. J Am Med Inform Assoc 2011;18(3):322-6. [10] Schnipper JL, Ndumele CD, Liang CL, Pendergrass ML. Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: results of a clinical trial. J Hosp Med 2009;4(1):16-27. [11] Asaro PV, Sheldahl AL, Char DM. Embedded guideline information without patient specificity in a commercial emergency department computerized order-entry system. Acad Emerg Med 2006;13(4):452-8. [12] Ozdas A, Speroff T, Waitman LR, Ozbolt J, Butler J, Miller RA. Integrating "best of care" protocols into clinicians' workflow via care provider order entry: impact on quality-of-care indicators for acute myocardial infarction. J Am Med Inform Assoc 2006;13(2):188-96. [13] Ballard DJ, Ogola G, Fleming NS, Heck D, Gunderson J, Mehta R, et al. The Impact of Standardized Order Sets on Quality and Financial Outcomes. 2008. [14] Hauck LD, Adler LM, Mulla ZD. Clinical pathway care improves outcomes among patients hospitalized for community-acquired pneumonia. Ann Epidemiol 2004;14(9):669-75. [15] King WJ, Le SN, Sampson M, Gaboury I, Norris M, Moher D. Effect of point of care information on inpatient management of bronchiolitis. BMC Pediatr 2007;7:4. [16] Micek ST, Roubinian N, Heuring T, Bode M, Williams J, et al. Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med 2006;34(11):2707-13. [17] Caslin EK, Beitler D, Arthur D, Dennison-Himmelfarb C. 8. Information technology improves heart failure core measure compliance and readmission rates. The Journal of Acute and Critical Care 2011;40(4):374. [18] Chima CS, Farmer-Dziak N, Cardwell P, Snow S. Use of technology to track program outcomes in a diabetes self-management program. J Am Diet Assoc 2005;105(12):1933-8. [19] Shapiro NI, Howell MD, Talmor D, Lahey D, Ngo L, Buras J, et al. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med 2006;34(4):1025-32.  L. Ahmadian and R. Khajouei / Impact of Computerized Order Sets on Practitioner Performance 1131View publication stats

Impact of computerized order sets on practitioner performance.

http://eprints.kmu.ac.ir/27641/1/Impact%20of%20computerized%20order%20sets%20on%20practitioner%20performance.pdf

Impact of computerized order sets on practitioner performance.

Abstract

Similar works

Full text

Available Versions

Simorgh Research Repository