Computerized physician order entry in the critical care and general inpatient setting: A narrative review
Section snippets
Methods
The citation search strategy was restricted to English language peer-reviewed journals and included several approaches. Electronic database searches were conducted in October 2003 and included Ovid MEDLINE from dates January 1, 1966 to September 1, 2003, Premedline, EMBASE, and All EBM Reviews (which includes the Cochrane Database of Systematic Reviews, the American College of Physicians [ACP] Journal Club, the Database of Abstracts of Reviews, and Effects and the Cochrane Central Registry of
Study identification and selection
Studies of CPOE included for this review were conducted on hospitalized patients and categorized to general care units and critical care units. Studies conducted in ambulatory settings, including emergency departments, were excluded from analysis. Study designs acceptable for this review were prospective randomized controlled trials (RCTs) including quasi-randomized processes such as alternate allocation and prospective observational studies with controls such as interrupted time series.
Results
A total of 18 articles satisfied the selection criteria, including 2 studies of CPOE in critical care settings,13, 14 8 studies of CPOE in general inpatient care settings15, 16, 17, 18, 19, 20, 21, 22 and 8 studies conducted in both critical care and general inpatient care settings.23, 24, 25, 26, 27, 28, 29, 30 With the exception of a single pediatric study,14 the remaining studies were only conducted in adult patient settings. The pediatric study was included because it satisfied our
Discussion
While the number of well-conducted trials of CPOE in the general care and especially critical care settings are still small, there is a growing accumulation of data supporting the beneficial effects of CPOE and CDSS. Many of these studies include both general and critical care units; more critical care data would be valuable. Nevertheless, the findings summarized in this review are examples of ongoing research efforts that are building the groundwork to validate Reed Gardner’s predictions from
Acknowledgements
The author thanks Ms. Tiffany Wang for her assistance in preparing the manuscript, and Dr. David W. Bates for his thoughtful review and mentorship.
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