- The study relied upon time-series comparisons. Because of the scope
of the implementation of the order entry system, the implementation
could not be done in a simultaneous randomized fashion.
- Time between interventions may have resulted in differences in physicians,
patient population, practices, medications used. Most notably study
had to correct for error rate and ADEs associated with greater use of
multiple sedatives in intervention group. Multiple sedative use accounted
for 42% of preventable ADEs in the intervention group.
- Costs of ADEs can be extraordinary.3
- Serious errors cannot be prevented if important information is not
entered into the computer. Seven serious allergy errors were not caught
because new allergies discovered during the hospitalization were not
- Effect of computer system likely is lower limit of what can be accomplished
because a great many potential functions of the POES were not implemented.
- Adverse drug events account for 19% of injuries in hospitalized patients.1
- The rate of adverse drug events occurs in a range 0.7 to 6.5 per hundred
admissions, depending on the definition of the degree of adverse event. The
most frequent errors are at the ordering stage.3
- A computerized decision support tool has been used for selection of
antibiotic and anti-infective substances in critically ill patients
linked to the computer-based patient records and microbiological results
systems. The program presented detailed epidemiological recommendations
and warnings regarding drug use and suggested proper antibiotic selection
to the ordering physician. There were a number of valuable outcomes
including a reduction in antibiotic use, number of doses and cultures
ordered, a reduction in the length of stay in the intensive care unit
and in the total hospital stay from 4.9 to 2.7 days and 12.9 to 19,
respectively. Total costs were reduced from $38,283 to $26,315 per hospital
stay. Mortality was decreased by 4%.2
- The University of Michigan Medical Center uses a critical care information
system that predicts and analyzes patient outcomes. In its 20-bed medical
ICU unit, savings in direct variable costs were more than $3 million
per year, coming largely from reduced nursing staffing and pharmacy
costs. Average length of stay in the ICU declined 40% during the ensuing
two and a half years, from 6.9 days to 4.1 days. They reduced its percentage
of low-risk ICU admissions from 17% to fewer than 10%.6
Leape LL, Brennan TA, Laird NM. The nature of adverse events in
hospitalized patients. N Engl J Med 1991; 324:377-384.
Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted
management program for antibiotic and other anti-infective agents.
N Eng J Med 1998; 232-238.
Bates DW, et al. Effect of computer prescribing on preventing
medication errors. JAMA, 1998; 280(15):1311-1316.
Shiffman RN, Brandt CA, Freeman BG. Transition to a computer-based
record using scannable, structured encounter forms. Arch Ped
Adolesc Med, 1997; 151(12):1247-1253.
Bates DW, Cullen DJ, et al. Incidence of adverse drug events and
potential adverse drug events, implications for prevention. JAMA,
Dr. Charles Watts, University of Michigan, Personal Communication.
Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician impatient
order writing on microcomputer workstations. JAMA, 1993;