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Objectives: Computerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).
Methods: We conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1-5) individually, as well as for admitted patients only.
Results: A significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients' LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3-5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.
Conclusions: CPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.
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http://dx.doi.org/10.1017/cem.2016.11 | DOI Listing |
Heliyon
December 2024
School of Business Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China.
Land use planning tools are essential for effective land management. However, existing research has not thoroughly explored the evolution and future potential of these tools. This study addresses this gap through comprehensive literature review and data collection, mapping the progression of land use planning tools from their inception to their future trajectories.
View Article and Find Full Text PDFPlast Reconstr Surg Glob Open
December 2024
From the Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Background: Three-dimensional (3D) models generated from computed tomography (CT) images efficiently and accurately complement surgical comprehension. Additionally, computer modeling provides a substrate for comparative analysis of the treated orbit volume. This study aimed to investigate cases of orbital bone fractures with regard to orbital-defect correction, through 3D computational structural modeling and evaluation of orbital volume.
View Article and Find Full Text PDFPan Afr Med J
December 2024
Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir University, Monastir, Tunisia.
The intrauterine device (IUD) is a widely utilized contraceptive method. In cases of uterine rupture, an IUD can migrate to the intra-abdominal or pelvic cavity, leading to various complications such as gastrointestinal perforation. The aim of this study was to report a case of a 29-year-old woman presented with acute left lumber pain.
View Article and Find Full Text PDFJ Diabetes Sci Technol
December 2024
Charles R. Drew University, Los Angeles, CA, USA.
Primary care clinicians (PCCs) manage 90% of patients with diabetes, 30% of whom require insulin with a substantial number poorly controlled because of the challenges that PCCs face (time constraints and lack of experience). The author has developed Federal Drug Administration cleared and Conformite Europeenne mark registered comprehensive computerized insulin dose adjustment algorithms (CIDAAs) to enable PCCs to significantly lower HbA1c levels in insulin-requiring patients. Reports sent to PCCs contain scatter plots of glucose readings, their organization into pre- and postprandial and before bedtime values, their analyses, and recommendations for insulin dose adjustments (if indicated) that the PCC can accept or modify.
View Article and Find Full Text PDFBrain Behav Immun
December 2024
Department of Psychology, and Brain Health Research Centre, University of Otago, William James Building, 275 Leith Walk, Dunedin 9054, New Zealand. Electronic address:
To date, 770 million people worldwide have contracted COVID-19, with many reporting long-term "brain fog". Concerningly, young adults are both overrepresented in COVID-19 infection rates and may be especially vulnerable to prolonged cognitive impairments following infection. This calls for focused research on this population to better understand the mechanisms underlying cognitive impairment post-COVID-19.
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