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

Abstract

Case description: We evaluated the effects of integrating order subsets for the most common medical diagnoses into a general medical admission order set of our electronic medical records (EMR) in order to improve order set integration by clinicians.

Methods of implementation: We identified the most common primary and secondary diagnoses for patients admitted to our medical service and developed order subsets comprising only of the orders necessary for the management of these individual diagnoses. Using the capabilities of our computerized physician order entry (CPOE), we nested these order subsets into the general order set and evaluated the resulting change in order set utilization by our clinicians.

Example and observations: The total number of order sets used by clinicians in all departments increased fivefold during the 16-month period following the implementation of the integrated order sets in July 2008. A before and after time series was used to analyze the trend in increased order set usage and showed an effect of the intervention (p=0.023).

Discussion: Integration of disease specific order subsets into a single general admission order set significantly improved the overall adoption of order sets by clinicians. This provides health care systems with the opportunity to improve patient safety and implement evidence based care in clinical practice.

Figure 1

Screenshot of the comprehensive medicine admission order set showing its nested components.

Figure 2

Time series analysis.

Figure 3

Comparison of the nested and non-nested numbers of order sets for non-acute coronary syndrome chest pain.

Figure 4

Number of nested order sets within the complete medical order sets for the Internal Medicine Department. CAP, community acquired pneumonia; COPD, chronic obstructive pulmonary disease.