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Streamlining Pediatric Emergency Medical Treatment

Improving Quality of Care with Computer Physician Order Entry

7/13/2009 

In the fast paced world of pediatric emergency medicine, accuracy and attention to detail are important to ensure patient safety. Children’s Hospital Central California’s Emergency Department’s (ED) use of computerized physician order entry (CPOE) improves medication safety, allows for better care coordination and reduces wait times. An early adapter, Children’s Hospital implemented CPOE in 2007 when less than 17 percent of hospitals with more than 200 beds were using the technology. Physicians utilize CPOE to ensure patient safety

“It takes some of the human errors out of patient care,” said Donna Wyman, Emergency Department Supervisor. “When you’re dealing with the interpretation of handwriting that is sometimes rushed it can lead to errors. CPOE helps ensure the patient gets the prescribed medicine.”

CPOE allows physicians to enter medical orders such as medications, X-rays and IVs into a computer program. Physicians can check for drug-drug interactions and drug allergies, monitor patient dosage levels and reduce errors from look-a-like and sound-a-like drugs. Also built into the program are order sets to standardize practice. An interdisciplinary team developed them to promote safety and efficiency, especially in complex situations.

“It has improved our ability to move patients through the ED,” said Lawrence Satkowiak, Emergency Department Medical Director. “Orders are easier to read, the system is quicker than writing out the orders, and there is no paper that can get lost. All of this makes it safer for our patients.”

At all times, doctors, nurses and support staff can look at electronic tracker boards or computers to see how long a patient has been there and where they are in their journey through the ED. Departments outside the ED such as medical imaging are notified electronically when a patient needs an X-ray or MRI. When patients are transferred to an inpatient unit, nurses can access their charts prior to their arrival and have a head start on coordinating their care.

“In the ED, you’re in and out of rooms, trying to do work-ups and those kinds of things real fast,” said Wyman. “The physician doing the order entry takes the guesswork out of what is being requested. Everyone is communicated to at the same time.”

The transition to CPOE has played an integral role in enhancing the quality of care offered in the ED. By the end of 2007, the average wait time to see a doctor dropped to 50 minutes. The number of patients who leave without treatment (LWOT) also has dramatically improved, decreasing from 12 percent in 2005 to 1.5 percent in 2008.

Years of preparation and planning went into the ED’s successful rollout of CPOE  In 2004, physicians began using computers to order diagnostic tests including labs and imaging. A year later, discharge instructions were added. Now ED doctors use computers for medical orders all the time except when dealing with a critical care patient.

“The safety it provides to the patient is why we do what we do,” said Wyman. “It is time consuming for the provider, but it results in the right medication being prescribed with the right dosage.”

Within the next 18 months, Children’s plans to expand CPOE throughout the Hospital to provide this improved level of safety and quality to all patients.