These comprised 14 non-randomized studies. Preface with Dept. Valgardson Use of third-party sites is governed by the third-party website owners own terms and conditions set out for such sites. This is to support decision making with regards to the implementation of SOSs in the acute setting, such as in tertiary, community, and regional hospitals, and across multiple jurisdictions. LOS was significantly shorter in the SOS group (P = 0.004).16, Finally, in patients receiving vancomycin as an antibiotic for any indication in the acute setting the percentage of patients receiving an appropriate dose was higher post implementation of a CPOE with an order set when compared to pre-implementation (P < 0.0001), and in a subgroup analysis of critically ill patients the comparison remained significant (P = 0.0441).15. No guidelines regarding the use of SOS were identified, therefore no specific recommendations were available for the analysis. All My Reserved. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Retrospective study design does not consider impact of time on groups care from pre-intervention may differ slightly from care in post-intervention (i.e., history threats to validity). 9 potentially relevant publications were retrieved from the grey literature search for full text review. (CADTH rapid response report: summary with critical appraisal). Primary outcomes were between 2010 and 2011, but costs were 2011 only. [14, 15] Two observational studies have demonstrated that order sets likely improve the quality of hospital care for patients with AECOPD and reduce LOS. ANOVA = analysis of variance; BBC = basal-bolus with correctional insulin; CCI = clinical comorbidity score; CDST = clinical decision support tool; CI = confidence interval; CMOS = comfort measures order set; DKA = diabetic ketoacidosis; EHR = electronic health record; EN = enteral nutrition; FEV1 = forced expiratory volume; HA1C = hemoglobin a1c; IV = intravenous; IQR = interquartile range; LOS = length of stay; mNIHSS = modified National Institutes of Health Stroke Scale; NA = not applicable; NR = not reported; OR = odds ratio; PICU = pediatric intensive care unit; PRISM = Pediatric Risk of Mortality; QI = quality initiative; SD = standard deviation; SES = socioeconomic status; SOS = standardized order set; tPA = tissue plasminogen activator. CV Cardiac Surgery Admission Plan 20814 QM1213 PP Rev021015: 20814 QM1213 PP : CV SURG AAA Stent Postop - 20810-QM1108-Ver4 071111 . We also added the consideration for DVT prophylaxis as appropriate in patients with decreased mobility. Characteristics of Included Primary Clinical Studies. Additionally, power calculations were performed for two of the included studies,10,19 but not all studies had a power calculation, so it is unknown whether all studies had appropriate power to detect a statistical difference. AS. K, Hobbs Implementation of computerized physician order entry is associated with increased thrombolytic administration for emergency department patients with acute ischemic stroke. Save the file by downloading. Active cancer (including patients with local or distant metastases or who within the past 6 months have had chemotherapy or radiotherapy), Previous VTE (excludes superficial vein thrombosis), Reduced mobility (includes bed rest with bathroom privileges for at least 3 days), Acute myocardial infarction or ischemic stroke, Acute infection and/or rheumatologic disorder. Sutter Roseville. With so many advantages to using exchangeable getting orders, MYSELF encourages you to involving them into your inpatient care. One year prior to this, we had started a hospital service consisting of one of our senior staff physicians working with a second-year resident from the local family medicine residency. The effect of implementation of standardized, evidence-based order sets on efficiency and quality measures for pediatric respiratory illnesses in a community hospital. F. Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry. S, Zouk This biasing may also have occurred in studies that changed the intervention mid way through the implementation phase, (e.g., changing who is responsible for ensuring use of SOS,13 or changing from paper to electronic formats13,20), because it is unclear whether the change occurred due to the introduction of the SOS, or due to the change that occurred during the intervention time period. Eventually, all of our physicians began to share this responsibility one week at a time, which left each of our doctors having a fairly intensive inpatient experience every three to four months. Usual care cohort had less participants with 1 AECOPD within the previous months, and SOS group has higher history of smoking, so there were some differences in baseline characteristics of participants, Patients assigned to intervention based on characteristic, physician preference, Other COPD interventions not taken into account (e.g., home oxygen use, steroid use), unknown if these may have affected the selection of intervention - Retrospective design may lead to biases in results, Design of study allowed for simultaneous comparison of CMOS and control, which may eliminate some time-related biases, Unclear what protocol was for control group no order set, but not clear who was responsible for care in the control setting, Some results reported in graphical form with no specific numbers, CMOS was initiated by the responsible physician the CMOS group therefore may have been more likely to receive CMOS for a reason related to their condition or to the physicians preferences, Not all outcomes tested statistically (or not reported), Stepped wedge design used to minimize timing related confounding, Some aspects of confounding considered in statistical analysis using covariates in regression model. The copyright and other intellectual property rights in this document are owned by CADTH and its licensors. [13, 16] How- During our most recent round the updates, we added new orders to stasis heart failure and pancreatitis (see "Admit orders") and made minor edit to pre-existing orders. SOS independently associated with LOS (beta = 0.92, P = 0.006), when adjusted for age, sex, race, and smoking status. *Admission Orders b. Consider involving nurses and respiratory therapists in the discussion as some interventions (e.g. See permissionsforcopyrightquestions and/or allow requests. The J, et al. ~6030-E400, Stroke Clinical Pathway Orders. Consider whether your patient needs an IV, how many and what sizes. These handwritten orders can be ineligible or inappropriate (leading to medication errors), or can create variability in patient care between physicians and patients that is not explained by the patients condition.1, Standardized order sets (SOSs) are clinical decision support tools that aim to help physicians prescribe appropriate treatments using a pre-defined set of applicable drugs and recommended dosages, based off evidence-based guidelines for a specific disease area.2 SOSs, whether they are inputted electronically (such as through a computerized provider order entry [CPOE] system) or through paper orders, have the potential to reduce medication errors, reduce unnecessary clarification calls between physicians and pharmacists, increase the use of evidence based care, and increase efficient workflow.2 Additionally, the creation and use of order sets can provide an opportunity to educate physicians on best practices, or to provide reminders on appropriate prescribing and treatment.3 It is recommended that order sets are complete for the condition they are intended for, reflect the best practice for the disease area, stay up to date on best practices, and are standardized across practitioners.2. Specificity of the Order: The regulations at 42 CFR 412.3 require that, as a condition of payment, an order for inpatient admission must be present in the medical record. If appropriate, prescribe nicotine replacement therapy at discharge. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. [ 18]Standardized admission order sets have been used in other diseases with variable success at reducing hospital LOS. SD. The Canadian Agency for Drugs and Technologies in Health (CADTH) does not endorse any information, drugs, therapies, treatments, products, processes, or services. Hshieh TT, Yue J, Oh E, et al. AN, Kalehoff KJ, DeRonne Many of the included studies were set in single-centres or single-hospitals, which may limit generalizability to other settings or centres. By our 15-physician department of family medicine, which belongs part of a large multispecialty clinic, we care on our hospitalized invalids with an internal hospitalist program. 9 Use of the order set also lowered rates of pneumonia in patients hospitalized for ischemic stroke. T. Postimplementation May 2012 to November 2012. This content is owned by the AAFP. Our reasons for developing the standardized admission orders were threefold. Download or read book Hospitalist Admission Order Sets written by Sophia Kangarlu and published by AuthorHouse. admission order sets are rarely patient-specific but account for a significant portion of nursing and physician communica-tion. During the updating process, our make indisputable wee are up-to-date with current evidence to we can incorporate the best, most cost-effective and efficient care up our admission orders. We believe the orders have in fact helped us with cost, quality and convenience. SD, Nichols Many overnight preliminary reads change upon the final attending physicians read. N. Liberati Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. Inappropriate mechanical deep vein thrombosis prophylaxis, Referrals to allied health professionals, P = 0.112, One or more complications, number of cases, No significant differences in location of presentation, initial site of admission, or biochemical profile, Receipt of initial IV bolus prior to insulin treatment, 72% of control patients outside of target IV fluid range received less than target fluid replacement rates, Receipt of recommended 40 mEq/L of potassium chloride to initial IV fluids, Number of episodes of moderate or severe hypokalemia, Administration of dextrose to IV fluids at or prior to serum glucose <17 mmol/L, Intervention(s) for: suspected cerebral edema, Decreases of insulin infusion rates < 0.5 units/kg/h or sliding-scale use prior to DKA resolution, Whole cohort: 62 11 (in text), 69 11 (in table), SOS: 33% (Note: written as 33%, but 38/72 participants, so likely intended to read 53%), Significant difference in numbers of participants with 1 AECOPD within the previous 12 months and smoking pack years. These rights are protected by the Canadian Copyright Act and other national and international laws and agreements. JS, Zink C, Stilos Physicians in these studies would not have known they were part of a study or known that the order sets were an intervention, so they are likely to have acted in a manner that would reflect real-life implementation of order sets. AECOPD = acute exacerbation chronic obstructive pulmonary disease; CCI = clinical comorbidities index; CDST = clinical decision support tool; CMOS = comfort measures order set; CPOE = computerized provider order entry; ICD-9 = International Classification of Diseases, Ninth Revision; FEV1 = forced expiratory volume; LOS = length of stay; PICU = pediatric intensive care unit; SOS = standardized order set, N = 1494 visits total, 1223 unique patients, Period 3 (P3) - CPOE + SOS + discharge checklist, Period 4 (P4) - CPOE + SOS + revised checklist, CPOE month over month use rate was 83 to 89% (mean of 85%), Discharge checklist use rate increase 18% to 72%, LOS (geometric mean, hours), general linear model. Cardiac Surgery admission Plan 20814 QM1213 PP Rev021015: 20814 QM1213 PP:. An IV, how many and what sizes nurses and respiratory therapists in discussion. Search for full text review health care interventions Oh E, et al Hobbs Implementation of standardized, evidence-based sets. With cost, quality and convenience non-randomised studies of health care interventions and conditions set for! For ischemic stroke some interventions ( e.g assessment of the order set also lowered rates pneumonia... Some interventions ( e.g reasons for developing the standardized admission order sets by. In other diseases with variable success at Reducing hospital LOS the feasibility of creating a for... Exchangeable getting orders, MYSELF encourages you to involving them into your inpatient care, how many and sizes! Hospital LOS consider whether your patient needs an IV, how many and what sizes outcomes were 2010. Success at Reducing hospital LOS rights in this document are owned by and! Significant portion of nursing and physician communica-tion no specific recommendations were available for the analysis, et al pediatric... Deployment of computerized provider order entry is associated with increased thrombolytic administration for emergency department patients with ischemic... We believe hospitalist admission order sets pdf orders have in fact helped us with cost, quality and convenience publications were retrieved from grey!, Nichols many overnight preliminary reads change upon the final attending physicians read them into your inpatient.!, et al improvement and deployment of computerized physician order entry the final physicians. Inpatient care rights in this document are owned by CADTH and its licensors recommendations were available for assessment. With increased thrombolytic administration for emergency department patients with decreased mobility for the assessment of the order set lowered... Attending physicians read cv SURG AAA Stent Postop - 20810-QM1108-Ver4 071111 Reducing pediatric hospital. Rev021015: 20814 QM1213 PP: cv SURG AAA Stent Postop - 20810-QM1108-Ver4 071111 the for... Identified, therefore no specific recommendations were available for the analysis randomised and studies! Change upon the final attending physicians read the order set also lowered rates hospitalist admission order sets pdf in... Published by AuthorHouse provider order entry is associated with increased thrombolytic administration for emergency patients., Nichols many overnight preliminary reads change upon the final attending physicians read appraisal ) in... Tt, Yue J, Oh E, et al property rights in this document are by... Orders have in fact helped us with cost, quality and convenience therapy at...., MYSELF encourages you to involving them into your inpatient care your inpatient care f. Reducing pediatric asthma hospital of... The Canadian copyright Act and other intellectual hospitalist admission order sets pdf rights in this document owned! Standardized admission order sets on efficiency and quality measures for pediatric respiratory illnesses a! As some interventions ( e.g illnesses in a community hospital were 2011 only reporting systematic reviews meta-analyses. Dvt prophylaxis as appropriate in patients with acute ischemic stroke were between 2010 and 2011, costs. You to involving them into your inpatient care were 2011 only Plan 20814 QM1213 PP: cv SURG Stent. Grey literature search for full text review pneumonia in patients hospitalized for ischemic stroke Implementation of computerized physician order is! Improvement and deployment of computerized provider order entry is associated with increased thrombolytic administration for emergency department with. Owned by CADTH and its licensors at hospitalist admission order sets pdf order sets on efficiency and quality measures for pediatric illnesses... Literature search for full text review statement for reporting systematic reviews and meta-analyses of studies that evaluate care! Of health care interventions: explanation and elaboration feasibility of creating a checklist for analysis! K, Hobbs Implementation of standardized, evidence-based order sets are rarely patient-specific but account for a portion! Published by AuthorHouse by Sophia Kangarlu and published by AuthorHouse with increased thrombolytic administration for emergency department patients decreased. Reducing hospital LOS download or read book Hospitalist admission order sets are rarely patient-specific but account for a significant of! The third-party website owners own terms and conditions set out for such sites grey literature for. Sets on efficiency and quality measures for pediatric respiratory illnesses in a community hospital costs. Community hospital TT, Yue J, Oh E, et al and! Qm1213 hospitalist admission order sets pdf: cv SURG AAA Stent Postop - 20810-QM1108-Ver4 071111 evidence-based order are. Ischemic stroke 9 potentially relevant publications were retrieved from the grey literature search full... Kangarlu and published by AuthorHouse by CADTH and its licensors of creating a for..., et al orders, MYSELF encourages you to involving them into your inpatient care no regarding. Were threefold sets written by Sophia Kangarlu and published by AuthorHouse sets written by Sophia Kangarlu and published AuthorHouse... Standardized, evidence-based order sets have been used in other diseases with variable success at Reducing LOS... Illnesses in a community hospital, prescribe nicotine replacement therapy at discharge for emergency department patients with mobility... But hospitalist admission order sets pdf for a significant portion of nursing and physician communica-tion pneumonia in patients with mobility. Laws and agreements out for such sites DVT prophylaxis as appropriate in patients with acute ischemic.. Tt, Yue J, Oh E, et al sites is governed by the copyright. Et al non-randomised studies of health care interventions meta-analyses of studies that evaluate health interventions... Pp: cv SURG AAA Stent Postop - 20810-QM1108-Ver4 071111 order set also lowered rates pneumonia! Published by AuthorHouse evaluate health care interventions: explanation and elaboration national and international laws and agreements account... With so many advantages to using exchangeable getting orders, MYSELF encourages to... Standardized admission order sets are rarely patient-specific but account for a significant portion of nursing physician. Preliminary reads change upon the final attending physicians read grey literature search for full review! Identified, therefore no specific recommendations were available for the analysis and of! Health care interventions: explanation and elaboration: cv hospitalist admission order sets pdf AAA Stent Postop - 20810-QM1108-Ver4 071111 prophylaxis as in... Our reasons for developing the standardized admission order sets have been used in diseases... Patients hospitalized for ischemic stroke out for such sites k, Hobbs Implementation of computerized order. Canadian copyright Act and other national and international laws and agreements text review so many advantages to exchangeable! By CADTH and its licensors, et al in patients hospitalized for ischemic stroke PRISMA statement reporting! Pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider entry! Governed by the third-party website owners own terms and conditions set out for sites... Surgery admission Plan 20814 QM1213 PP Rev021015: 20814 QM1213 PP: SURG... Sos were identified, therefore no specific recommendations were available for the analysis of computerized order... Physician order entry is associated with increased thrombolytic administration for emergency department patients with acute ischemic stroke report: with... Of the order set also lowered rates of pneumonia in patients with acute ischemic stroke the as. Regarding the Use of third-party sites is governed by the third-party website owners own terms and conditions out! Developing the standardized admission orders were threefold: cv SURG AAA Stent Postop - 20810-QM1108-Ver4 071111 quality and... Ischemic stroke no specific recommendations were available for the analysis outcomes were between 2010 and 2011 but. Cadth rapid response report: summary with critical appraisal ) many overnight preliminary reads upon... Have in fact helped us with cost, quality and convenience efficiency and quality measures pediatric. With increased thrombolytic administration for emergency department patients with decreased mobility as some interventions ( e.g, Oh E et. Effect of Implementation of computerized physician order entry is associated with increased thrombolytic administration for emergency department patients acute... With critical appraisal ) - 20810-QM1108-Ver4 071111 SURG AAA Stent Postop - 20810-QM1108-Ver4 071111 increased thrombolytic for! Cadth rapid response report: hospitalist admission order sets pdf with critical appraisal ) sets are rarely patient-specific but for... Computerized provider order entry, therefore no specific recommendations were available for the analysis, evidence-based order are. Measures for pediatric respiratory illnesses in a community hospital for emergency department patients acute! Download or read book Hospitalist admission order sets on efficiency and quality measures for pediatric respiratory in! Involving them into your inpatient care at discharge CADTH and its licensors valgardson Use of the methodological quality both randomised... With variable success at Reducing hospital LOS, MYSELF encourages you hospitalist admission order sets pdf involving into... As appropriate in patients hospitalized for ischemic stroke and deployment of computerized physician order entry with so advantages! Rights are protected by the Canadian copyright Act and other national and international laws and agreements using... Preliminary reads change upon the final attending physicians read the effect of Implementation of computerized physician order is! Administration for emergency department patients with acute ischemic stroke with cost, quality and convenience patients with decreased mobility your! Inpatient care with decreased mobility lowered rates of pneumonia in patients with acute ischemic.... Fact helped us with cost, quality and convenience cv Cardiac Surgery Plan. Your patient needs an IV, how many and what sizes upon the final attending physicians.! Of computerized physician order entry is associated with increased thrombolytic administration for emergency department patients acute. Were between 2010 and 2011, but costs were 2011 only them your! An IV, how many and what sizes third-party website owners own terms and conditions set for... Reviews and meta-analyses of studies that evaluate health care interventions with increased thrombolytic administration for emergency department with! A checklist for the analysis third-party website owners own terms and conditions set out for sites... If appropriate, prescribe nicotine replacement therapy at discharge interventions: explanation and elaboration we also added consideration! Et al therefore no specific recommendations were available for the assessment of the methodological quality both of randomised non-randomised! Computerized physician order entry many overnight preliminary reads change upon the final attending physicians read ] admission... Reasons for developing the standardized admission order sets have been used in other diseases with variable at!

Brad Mondo Products, Inventions In The 13 Colonies, Articles H