Council on Medical Student Education in Pediatrics

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COMSEP 2009 Baltimore Meeting with APPD

Platform Presentation:


The Effect of the Implementation of an On-Line Order Entry System on Resident Compliance with Duty Hour Regulations: Trading Legislative Compliance for Patient Safety?

Authors:
Hilary M. Haftel, MD, MHPE, David Hanauer, MD, John Schmidt, MD, University of Michigan, Ann Arbor, MI

BACKGROUND: Computerized Physician Order Entry (CPOE) has been shown to have several beneficial outcomes, including reduction in medication errors, reduced test ordering, improved medication turn-around time, and reduction in length of stay. It has also been shown, however, to increase physician front-end work time. Residents are the physicians primarily responsible for order entry and the subsequent increased physician work time falls to them. Residents are also expected to conform to Duty Hour Regulations that limit the amount of time any resident may spend on patient care activities. It is possible that adding the task of computerized order entry to a resident’s workload may result in an increase in duty hour violations. OBJECTIVE: This study analyzed the effect of CPOE on Duty Hour compliance in multiple inpatient and intensive care settings. DESIGN/METHODS: Duty hour logs for Pediatric and Medicine/Pediatrics Residents on inpatient and intensive care services prior to and following the initiation of CPOE were analyzed for duty hour violations. Descriptive statistics and t-tests were employed for data analysis. RESULTS: There was no significant increase in the number of duty hour violations subsequent to the initiation of CPOE, including total work hours and violations of the 24+6 hours rule in the Pediatric ICU and general inpatient services. Duty hour noncompliance was significantly increased, however, in the Neonatal ICU, the first unit to implement CPOE. These violations persist, but may be attributable to other factors. DISCUSSION: CPOE can be successfully implemented in multiple settings without additionally contributing to duty hour violations. In busy intensive care units with other factors contributing to increased physician workload, however, CPOE can contribute to physician work time sufficient to cause noncompliance with duty hour regulations, thus putting institutions at risk for ACGME penalty