Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: A systematic review and meta-analysis

To conduct a systematic review and meta-analysis of the impact of commercial computerized provider
order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay
(LOS), and mortality in intensive care units (ICUs).
Methods: We searched for English-language literature published between January 2000 and January 2016 using
Medline, Embase, and CINAHL. Titles and abstracts of 586 unique citations were screened. Studies were included
if they: (1) reported results for an ICU population; (2) evaluated the impact of CPOE or the addition of
CDSSs to an existing CPOE system; (3) reported quantitative data on medication errors, ICU LOS, hospital LOS,
ICU mortality, and/or hospital mortality; and (4) used a randomized controlled trial or quasi-experimental study
design.
Results: Twenty studies met our inclusion criteria. The transition from paper-based ordering to commercial
CPOE systems in ICUs was associated with an 85% reduction in medication prescribing error rates and a 12%
reduction in ICU mortality rates. Overall meta-analyses of LOS and hospital mortality did not demonstrate a significant
change.
Discussion and Conclusion: Critical care settings, both adult and pediatric, involve unique complexities, making
them vulnerable to medication errors and adverse patient outcomes. The currently limited evidence base requires
research that has sufficient statistical power to identify the true effect of CPOE implementation. There is
also a critical need to understand the nature of errors arising post-CPOE and how the addition of CDSSs can be
used to provide greater benefit to delivering safe and effective patient care.