Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-25T16:53:04.356Z Has data issue: false hasContentIssue false
  • English
  • Français

ORDER SETS IN HEALTH CARE: A SYSTEMATIC REVIEW OF THEIR EFFECTS

Published online by Cambridge University Press:  14 September 2012

Alvita J. Chan ,
Julie Chan ,
Joseph A. Cafazzo ,
Peter G. Rossos ,
Tim Tripp ,
Kaveh Shojania ,
Tanya Khan  and
Anthony C. Easty
Alvita J. Chan
Affiliation:
University Health Network; University of Toronto email: alvita.chan@uhn.ca
Julie Chan
Affiliation:
University of Toronto
Joseph A. Cafazzo
Affiliation:
University Health Network; University of Toronto
Peter G. Rossos
Affiliation:
University Health Network; University of Toronto
Tim Tripp
Affiliation:
University Health Network
Kaveh Shojania
Affiliation:
Sunnybrook Health Sciences Centre, University of Toronto
Tanya Khan
Affiliation:
Ontario Ministry of Health and Long-Term Care
Anthony C. Easty
Affiliation:
University Health Network; University of Toronto
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Order sets are widely used in hospitals to enter diagnosis and treatment orders. To determine the effectiveness of order sets in improving guideline adherence, treatment outcomes, processes of care, efficiency, and cost, we conducted a systematic review of the literature.

Methods: A comprehensive literature search was performed in various databases for studies published between January 1, 1990, and April 18, 2009. A total of eighteen studies met inclusion criteria. No randomized controlled trials were found.

Results: Outcomes of the included studies were summarized qualitatively due to variations in study population, intervention type, and outcome measures. There were no important inconsistencies between the results reported by studies involving different types of order sets. While the studies generally suggested positive outcomes, they were typically of low quality, with simple before-after designs and other methodological limitations.

Conclusions: The benefits of order sets remain eminently plausible, but given the paucity of high quality evidence, further investigations to formally evaluate the effectiveness of order sets would be highly valuable.

Keywords

Medical order entry systemsStandardizationClinical protocolsClinical decision support systemsDrug prescriptionsReview
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 3 , July 2012 , pp. 235 - 240
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Asaro, PV, Sheldahl, AL, Char, DM. Embedded guideline information without patient specificity in a commercial emergency department computerized order-entry system. Acad Emerg Med. 2006;13:452–458.Google Scholar
2.Biviano, AB, Rabbani, LE, Paultre, F, et al.Usefulness of an acute coronary syndrome pathway to improve adherence to secondary prevention guidelines. Am J Cardiol. 2003;91:1248–1250.CrossRefGoogle ScholarPubMed
3.Bobb, A, Payne, T, Gross, P. Viewpoint: Controversies surrounding use of order sets for clinical decision support in computerized provider order entry. J Am Med Inform Assoc. 2007;14:41–47.CrossRefGoogle ScholarPubMed
4.California Acute Stroke Pilot Registry Investigators. The impact of standardized stroke orders on adherence to best practices. Neurology. 2005;65:360–365.CrossRefGoogle Scholar
5.Campbell, EM, Sittig, DF, Ash, JS, et al.Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006;13:547–556.CrossRefGoogle ScholarPubMed
6.Chapman, G, Curtas, S, Meguid, MM. Standardized enteral orders attain caloric goals sooner: A prospective study. JPEN J Parenter Enteral Nutr. 1992;16:149–151.CrossRefGoogle ScholarPubMed
7.Chisolm, DJ, McAlearney, AS, Veneris, S, et al.The role of computerized order sets in pediatric inpatient asthma treatment. Pediatr Allergy Immunol. 2006;17:199–206.CrossRefGoogle ScholarPubMed
8.Clinical Quality Improvement Network Investigators. Influence of a critical path management tool in the treatment of acute myocardial infarction. Am J Manag Care. 1998;4:1243–1251.Google Scholar
9.Debrix, I, Tilleul, P, Milleron, B, et al.The relationship between introduction of American society of clinical oncology guidelines and the use of colony-stimulating factors in clinical practice in a Paris university hospital. Clin Ther. 2001;23:1116–1127.CrossRefGoogle Scholar
10.Elsasser, GN, Goodman, MD, Destache, CJ, et al.Preprinted risk assessment and prophylaxis order form for venous thromboembolism. Am J Health Syst Pharm. 2007;64:1294–1298.CrossRefGoogle ScholarPubMed
11.Garrelts, JC, Meister, A, Bond, J. Effect of preprinted order form on epoetin alfa prescribing. Am J Health Syst Pharm. 2007;64:1732–1738.CrossRefGoogle ScholarPubMed
12.Guyatt, GH, Oxman, AD, Kunz, R, et al.What is “quality of evidence” and why is it important to clinicians? BMJ. 2008;336:995–998.CrossRefGoogle Scholar
13.Healthcare Human Factors, University Health Network. Order sets in healthcare: An evidence-based analysis. http://www.ehealthinnovation.org/?q=node/485 Archived at: http://www.webcitation.org/5oq6cUjsq (accessed September 16, 2010).Google Scholar
14.Hughes, MR, Smith, CD, Tecklenburg, FW, et al.Effects of a weaning protocol on ventilated pediatric intensive care unit (PICU) patients. Top Health Inf Manage. 2001;22:35–43.Google ScholarPubMed
15.Koplan, KE, Regan, S, Goldszer, RC, et al.A computerized aid to support smoking cessation treatment for hospital patients. J Gen Intern Med. 2008;23:1214–1217.CrossRefGoogle ScholarPubMed
16.Micek, ST, Roubinian, N, Heuring, T, et al.Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med. 2006;34:2707–2713.CrossRefGoogle ScholarPubMed
17.Miller, SJ, North, GL, Anderson, WD. Parenteral nutrition order form to improve dextrose and lipid use. Am J Hosp Pharm. 1990;47:2515–2518.Google ScholarPubMed
18.Noschese, M, Donihi, AC, Koerbel, G, et al.Effect of a diabetes order set on glycaemic management and control in the hospital. Qual Saf Health Care 2008;17:464–468.CrossRefGoogle ScholarPubMed
19.O'Connor, C, Adhikari, NK, DeCaire, K, et al.Medical admission order sets to improve deep vein thrombosis prophylaxis rates and other outcomes. J Hosp Med. 2009;4:81–89.CrossRefGoogle ScholarPubMed
20.Rosenal, T, Fantin, L, Sinnarajah, A, et al.Optimizing standard patient management through order sets – Impact on care (blood cultures). Stud Health Technol Inform. 2009;143:487–495.Google ScholarPubMed
21.Theilen, BM, Gritzke, KA, Knutsen, PG, et al.Inpatient glycemic control on the vascular surgery service. Endocr Pract. 2008;14:185–191.CrossRefGoogle ScholarPubMed
22.Thiel, SW, Asghar, MF, Micek, ST, et al.Hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis. Crit Care Med. 2009;37:819–824.CrossRefGoogle ScholarPubMed
23.Thorn, DB, Sexton, MG, Semav, AP, et al.Effect of a cancer chemotherapy prescription form on prescription completeness. Am J Hosp Pharm. 1989;46:1802–1806.Google ScholarPubMed
24.Treece, PD, Engelberg, RA, Crowley, L, et al.Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit. Crit Care Med. 2004;32:1141–1148.CrossRefGoogle ScholarPubMed
25.University of Bern. STROBE checklist for cohort, case-control, and cross-sectional studies (Version 4). http://www.strobe-statement.org/index.php?id=available-checklists Archived at: http://www.webcitation.org/5oq5bf0Uv (accessed July 15, 2009).Google Scholar
26.Webb, LZ, Kuykendall, DH, Zeiger, RS, et al.The impact of status asthmaticus practice guidelines on patient outcome and physician behavior. QRB Qual Rev Bull. 1992;18:471–476.CrossRefGoogle ScholarPubMed
Supplementary material: File

Chan supplementary figures

Chan supplementary figures

Download Chan supplementary figures(File)
File 2.1 MB
Supplementary material: File

Chan supplementary tables

Chan supplementary tables

Download Chan supplementary tables(File)
File 100.4 KB