Dr. Andy

Reflections on medicine and biology among other things

Thursday, May 04, 2006


In December, I discussed a concerning publication from my own institution showing increased mortality in the ICU after implmentation of a computerized physician order entry system.

Well, the establishment has now had it's chance to respond, in a series of letters either critiqueing the study or arguing that the hospital didn't implement the CPOE properly (not that anyone could dispute that). I don't find them entirely convincing, but you can judge for yourself if your institution has free access.

And yes I took and extended break for no real reason. I've had a fair amount going on, got a bad cold, felt like I didn't have much to say, etc. I should be posting more regularly for the next while at least


At 11:26 AM, Blogger sailorman said...

Aren't arguments abour implementation merely poor statistics?One of the important measures of a curative protocol is whether it's too complex to perform well.

If I develop a wonderful surgical lung cancer protocol which is extraordinarily effective, but so sensitive to error and skill that it fails (and kills the patient) fairly often, it's not a god protocol.

Similarly, if the CPOE process is such that is is too damn difficult to implement without issues resulting from that complexity, any failure due to the complexity is properly attributable to the CPOE.

Otherwise, you cannot do a meaningful comparison of anything--"yes, charts work perfectly; they're just not implemented right!". Whatever.

That is why you can acheive positive results by changing PROCESSES as well as ACTIONS--e.g. requiring a formal, double checked, post-surgical sponge count for every patient might produce the same change in overall patient health as improving the quality of your postsurgical antibiotics.

I would expect that hospital folks would have enough grasp of statistics to understand that.


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