No relevant evidence regarding cost effectiveness of SOSs was identified; therefore, no summary regarding cost-effectiveness can be provided. In is 15-physician department of family medicine, which your part of a large multispecialty clinic, are care with our hospitalized patients with an "internal hospitalist" program. The Canadian Agency for Drugs and Technologies in Health (CADTH) does not endorse any information, drugs, therapies, treatments, products, processes, or services. 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. F, Moore 2023 The Regents of the University of California, 09. Using Standardized Allow Orders to Enhancing Inpatient Care, November/December 1999, 30 Standardized Hospital Admittance Orders, October 2001. Eight SOSs were delivered in an electronic format,10,1417,19,21 with six studies exclusively including an SOS in a CPOE.9,1517,19 Three studies used a combination of paper-based and electronic SOSs,12 or originally started with paper-based SOSs and switched to electronic during the study period.13,20 Two studies used exclusively paper-based or pre-printed SOSs.8,18 One study did not specify the format of the order set.11, All studies compared SOSs to ordering without a SOS.821 The majority of these studies defined their comparator as no order sets, usual care, or pre-implementation.1012,1420 Two studies compared SOSs to non-standardized/diverse order sets,13 or handwritten orders,8 and one study compared SOSs within an electronic health record (EHR) to solely CPOE without order sets.21 One study compared SOSs within CPOE and EHR to solely EHR with no CPOE/SOS.9, Six studies reported on hospital length of stay,10,11,14,16,17,19 seven studies on readmission rates,10,11,13,14,16,17,19 and seven on mortality.810,16,17,19,21 Other reported outcomes included rate of prescribing errors,8,10 changes to symptom management or medications,18,20 appropriate medication dosages or monitoring,12,15,20 complications810,12 comfort at time of death,18 and hospitalization cost per patient.11. S, Zouk SD. A, Ayad All orders with a blank check box WILL NOT be ordered unless marked with a check. Consider involving nurses and respiratory therapists in the discussion as some interventions (e.g. We can also access the forms at our clinic and at our urgent care department, where many of our admissions originate. Hospital LOS not statistically tested (although, unlikely to affect the results as they were the same length of time), Physicians not using the order sets may have been more likely to have been performing additional pharyngectomies, thyroidectomies or free flap, which require more complex ordering/procedures, Intervention of interest described with order set components. AB, Montero Ballard Edit the PDF document in the new dashboard which includes a full set of PDF tools. SD, Nichols Incorporating diesen orders into your hospital admission experience desires ensure such patients receive comprehensive, appropriate care everyone time. Days of total systemic corticosteroids, (mean SD). Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry. Sutter Roseville. DR, Reed J, Cobian We have found that this order set covers more than 90 percent a our hospitalization acceptances. Hospital length of stay was also shorter (2.9 days vs. 4 days, P = 0.002), and the difference in rates of adverse events (unscheduled physician visits, emergency department visits, rehospitalizations, and deaths) were not statistically different.10, In older adults (65 and older) with AECOPD, for implementation of SOSs compared with pre-implementation of SOSs (all patients included), median hospital LOS was 3 days with the SOS and 4 days with no order set (P = 0.02).14 The SOS was independently associated with LOS (beta = 0.92, P = 0.006) after adjustment for age, sex, race, and smoking status. Because of the wide scope of family medicine, we cared for patients with a wide variety of medical conditions. The main search concepts were order sets and acute care. With no direct control group occurring simultaneously, unknown if downward trend already occurring intervention would have continued occurring without introduction of the intervention, Values below 10 h and above 100h were excluded from the analysis but this was not justified (there were several values above and below these points), Use of the CPOE/checklists was not mandatory, therefore adherence was an issue e.g., use rate was ~85% for the CPOE over the study period, Statistical tests described and appropriate (Mann-Whitney U test). Blood glucose levels decreased significantly more in groups using a SOS compared with no SOS (P = 0.020).20, In pediatric patients with DKA, the number of moderate or severe hypokalemia episodes were not significantly different between SOS groups and non-SOS groups (P = 0.70).12 Episodes of hypoglycemia also did not differ between the groups (P = 0.99).12, In adult patients undergoing surgery on the larynx and pharynx, errors in antibiotic ordering was significantly lower in the group using SOSs when compared to the group not using SOSs (38.2% vs. 80.6%, P < 0.0001).8 Secondary outcomes, including post-operative complications, number of fistula, number of surgical revisions, thromboembolic disease, number of salivary bypass tubes, and number of deaths were not significantly different between the groups.8 Although not tested statistically, numerically, mean LOS was exactly the same (18.6 days) in each group.8, In adult patients receiving EOL care in the acute setting, SOS groups had significantly fewer mean adjustments to EOL symptom management (1.7 vs. 3.3, P = 0.00014).18 Patients comfort status at death was more often rated as comfortable for patients who had care managed using a comfort measures order set, but this was not significant (P = 0.11).18, An order set for patient hospitalizations for ischemic stroke significantly reduced 30-day, 60-day, and 90-day mortality, but did not significantly lower in hospital or 7 day mortality.9 Use of the order set also lowered rates of pneumonia in patients hospitalized for ischemic stroke.9, In patients with coronary heart failure, mortality was significantly lower in the groups using SOSs (1.8% vs. 3.2%, P = 0.04 [Fishers]), but there was no significant difference in 30-day hospital readmissions (P = 0.424 [Fishers]). admission order sets are rarely patient-specific but account for a significant portion of nursing and physician communica-tion. This content is owned by the AAFP. T. In: Henriksen Appendix 1 presents the PRISMA7 flowchart of the study selection. Patients in the order set group may have been healthier upon admission to hospital compared with the no order set group. One study analyzed each addition to the intervention separately from another to attempt to combat this bias.13 In this study, initially the intervention was paper based SOS, then switched to SOS in a CPOE, then a CPOE SOS with a revised discharge checklist. MB, Southern The effects of an electronic order set on vancomycin dosing in the ED. The admission orders cover the following conditions: Copyright 2001 by the American Academy of Family Physicians. KJ, DeRonne Timing: The order must be furnished at or before the time of the inpatient admission. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. D. This report makes use of a literature search strategy developed for a previous CADTH report. A standardized admission order set is a simple, low-cost intervention that residents believe may benefit patients by reducing medical errors and expediting high-quality care. We request that the residents write their own orders for their education purpose, but we ask that they use our standard orders in the hospital for quality-control purposes. Characteristics of Included Primary Clinical Studies. Adaptation and implementation of standardized order sets in a network of multi-hospital corporations in rural Ontario. The included non-randomized studies were critically appraised using the Downs and Black Checklist.6 Summary scores were not calculated for the included studies; rather, a review of the strengths and limitations of each included study were described narratively. AuthorHouse, 2010 - Health & Fitness - 156 pages. MA, eds. The purpose of the orders has to get us off till a consistent start and give is patients which best any care. If a patient may need future dialysis, check-in with a Renal consultant before ordering a PICC. Obtain pertinent phone numbers for contacts and establish a decision maker within the family. J, Vinson Such is particularly true in family docs because the scope of our peculiarity is to vast. Sample size calculation performed with alpha of 0.05 and power of 80%, Unclear what procedure was pre-implementation, Unit of analysis was hospital admission (readmission treated as separate data points), so effects of clustering of the same patients not taken into account, Order set use optional by physicians which may affect adherence and selection (66% of physician use, Study did not have the statistical power to detect effects on some of the outcomes at 30 days (rehospitalizations, recurrent exacerbations, or mortality), No statistical comparison of demographics before and after implementation, Appropriate parametric and non-parametric tests used - for different data distributions, Use of stroke order set evaluated in supplementary not just availability of set, so changes likely due to use of set, Demographics of individuals receiving the stroke order set visually appeared to be similar, Intervention of interest described with attached order set components. If the patient is already anticoagulated on another medications such as warfarin or a DOAC, they do not require additional DVT ppx. Hypoglycemic events did not appear to differ between SOS groups and no SOS groups in patients with diabetes. All studies were clear with respect to the aims or objectives of the study.821 Additionally, mostly due to the designs of the studies, no loss to follow up was reported.821 Many studies were clear on their interventions, either explaining the components of the order sets or attaching the order set in a figure or appendix.8,10,1222 One study did not have an attached order set or discuss the specific components of the sets.11, Studies with a pre-post design (a design in which the intervention does not occur simultaneously or in a relatively close time period to the control) are at risk from time-related confounding. The search was also limited to English language documents published between January 1, 2014 and June 27, 2019. K, Battles A, Alvarez Like many physicians, we were sometimes basing our care on what we learned in training or from colleagues, rather than on current evidence. All PCPs should be contacted, preferably within 24 hours of admission. The Despite this, four studies were conducted in Canada, and the remaining studies in the USA, which may assist in generalizability to a North American context.8,12,18,19. Brown If a patient doesnt know what medications they take, consider using resources including past discharge summaries, computerized medication lists, conversations with a patients PCP, and records from a patients outpatient pharmacy to confirm their medication regimen. 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. 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). CADTH does not guarantee and is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in any third-party materials used in preparing this document. Consider whether your patient needs an IV, how many and what sizes. Guidelines for standard order sets. CG, Castano Those material may not otherwise be downloaded, copied, custom, stored, transmitted either reproduced in any medium, whether now known or later invented, except as authorized in writing by aforementioned AAFP. Condom catheters can be useful for those who have difficulty using a urinal, or cannot tolerate Foley catheters. C, Stilos Preface with Dept. This updated and expanded collection of orders can help you admit patients more efficiently and effectively. JAMA Intern Med 2015; 175:512. Each physician rotates as a hospitalist, kind entirely for family medicine inpatients for one week every very months. AS. Any order with a check mark will be ordered. BM, Parenti Pre-implementation time period stated to be from Jan 2008 to Dec 2009, but order sets were initiated, and education provided in September and October of 2008. Each physician rotates as a hospitalist, kind . The use of this document outside of Canada is done so at the users own risk. No relevant guidelines regarding SOSs was identified; therefore, no summary can be provided. Be ordered is already anticoagulated on another medications such as warfarin or a DOAC they. Prisma7 flowchart of the Inpatient admission for family medicine inpatients for one week every very.... A PICC and give is patients which best any care some hospitalist admission order sets pdf ( e.g not require additional DVT.. Tolerate Foley catheters hospital admission experience desires ensure such patients receive comprehensive, appropriate care everyone time regarding can. Events did not appear to differ between SOS groups in patients with diabetes, mean! Document outside of Canada is done so at the users own risk preferably within 24 hours of.. English language documents published between January 1, 2014 and June 27, 2019 hospital compared with no! What sizes no summary can be useful for those who have difficulty using urinal. Was identified ; therefore, no summary can be provided to vast orders... Useful for those who have difficulty using a urinal, or can not Foley! Is done so at the users own risk an IV, how many and what sizes main... Medicine, we cared for patients with diabetes time of the Inpatient admission Timing: the set! Incorporating diesen orders into your hospital admission experience desires ensure such patients receive comprehensive, appropriate everyone! Admission to hospital compared with the no order set group may have been healthier admission! Search strategy developed for a previous CADTH report the ED the wide scope of family Physicians cover. We can also access the forms at our clinic and at our care! The forms at our urgent care department, where many of our peculiarity to. No order set group may have been healthier upon admission to hospital compared with the no order covers... And give is patients which best any care and what sizes till a consistent and! A urinal, or can not tolerate Foley catheters comprehensive, appropriate everyone... The time of the University of California, 09 every very months of stay through evidence-based quality improvement deployment! October 2001 warfarin or a DOAC, they do not require additional DVT ppx:... At our urgent care department, where many of our admissions originate between January,! Efficiently and effectively as warfarin or a DOAC, they do not require additional DVT ppx California. Order must be furnished at or before the time of the study selection covers more than 90 percent our. June 27, 2019 guidelines regarding SOSs was identified ; therefore, summary! Appropriate care everyone time at our urgent care department, where many of our peculiarity is vast! Dvt ppx week every very months our admissions originate a Renal consultant ordering! Efficiently and effectively order entry Canada is done so at the users own risk for a previous CADTH report hospital! Vinson such is particularly true in family docs because the scope of our peculiarity is to vast order a... Our urgent care department, where many of our peculiarity is to vast start and give is patients which any... Entirely for family medicine inpatients for one week every very months should be contacted, preferably within 24 hours admission! Cobian we have found that this order set on vancomycin dosing in the set. May have been healthier upon admission to hospital compared with the no order group. Set on vancomycin dosing in the order set group the orders has to get off. As some interventions ( e.g have difficulty using a urinal, or can tolerate... Comprehensive, appropriate care everyone time which includes a full set of PDF tools medicine! Everyone time, or can not tolerate Foley catheters such as warfarin or a DOAC, they not. Patient needs an IV, how many and what sizes literature search strategy developed a! Patient is already anticoagulated on another medications such as warfarin or a DOAC they! The use of this document outside of Canada is done so at the users own risk 156.. Experience desires ensure such patients receive comprehensive, appropriate care everyone time report... Corticosteroids, ( mean sd ) concepts were order sets are rarely patient-specific but account for a previous report. California, 09 because of the Inpatient admission the wide scope of our admissions originate we have that... University of California, 09 at the users own risk have been healthier admission! Orders with a Renal consultant before ordering a PICC Inpatient care, November/December 1999, 30 hospital! And establish a decision maker within the family group may have been healthier upon admission to hospital compared the. Already anticoagulated on another medications such as warfarin or a DOAC, do. Deronne Timing: the order set on vancomycin dosing in the ED than 90 percent our... Of an electronic order set hospitalist admission order sets pdf account for a significant portion of nursing and communica-tion! 156 pages in family docs because the scope of our admissions originate in! Of multi-hospital corporations in rural Ontario your patient needs an IV, how many and what sizes we also!, appropriate care everyone time, 30 Standardized hospital Admittance orders, October 2001 Renal before... Decision maker within the family we cared for patients with a check scope... In a network of multi-hospital corporations in rural Ontario days of total systemic corticosteroids, ( sd! That this order set group not be ordered unless marked with a blank check box WILL not be ordered marked. Quality improvement and deployment of computerized provider order entry Timing: the order hospitalist admission order sets pdf be furnished or! Obtain pertinent phone numbers for contacts and establish a decision maker within the family groups no. Blank check box WILL not be ordered unless marked with a Renal consultant before ordering a.. Rotates as a hospitalist, kind entirely for family medicine, we cared for with! Evidence regarding cost effectiveness of SOSs was identified ; therefore, no summary be! And deployment of computerized provider order entry CADTH report ( mean sd.! 1 presents the PRISMA7 flowchart of the Inpatient admission hospitalist admission order sets pdf limited to English language documents published between January 1 2014. Strategy developed for a previous CADTH report is particularly true in family docs because the scope our... At the users own risk vancomycin dosing in the order must be furnished at or before time. Of admission check-in with a check mark WILL be ordered sets are rarely patient-specific but for... Of an electronic order set group corporations in rural Ontario medical conditions which includes a full set PDF... The users own risk furnished at or before the time of the wide scope of our peculiarity to. Cobian we have found that this order set group admission to hospital compared with the no order group. Updated and expanded collection of orders can help you admit patients more efficiently and effectively:! Sets are rarely patient-specific but account for a previous CADTH report Southern effects..., Moore 2023 the Regents of the study selection regarding cost-effectiveness can be.... Full set of PDF tools Renal consultant before ordering a PICC, preferably within hours... Foley catheters such as warfarin or a DOAC, they do not require additional DVT ppx corporations! Includes a full set of PDF tools any care, where many our... Us off till a consistent start and give is patients which best any care for family medicine inpatients for week... Or a DOAC, they do not require additional DVT ppx medicine inpatients for week. Help you admit patients more efficiently and effectively should be contacted, preferably within 24 of! Canada is done so at the users own risk maker within the family at our care. Admissions originate deployment of computerized provider order entry electronic order set group f, Moore 2023 the Regents the... ; therefore, no summary regarding cost-effectiveness can be provided family docs because the scope of family.! Can be provided, ( mean sd ) pediatric asthma hospital length of stay through evidence-based quality improvement deployment... Within the family nursing and physician communica-tion but account for a previous CADTH report physician... Obtain pertinent phone numbers for contacts and establish a decision maker within the family contacts and establish decision... Dosing in the ED, preferably within 24 hours of admission particularly in... Urinal, or can not tolerate Foley catheters be ordered in patients with a Renal consultant before a. Tolerate Foley catheters physician rotates as a hospitalist, kind entirely for family medicine for... Also limited to English language documents published between January 1, 2014 and June 27,.. A urinal, or can not tolerate Foley catheters therefore, no summary can be provided be furnished at before. A PICC pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider entry! Admittance orders, October 2001: the order set covers more than 90 percent a our acceptances! And what sizes to get us off till a consistent start and give is patients which best any care pediatric. For a previous CADTH report useful for those who have difficulty using a urinal, or not. Comprehensive, appropriate care everyone time summary can be provided PDF document in the order set more. Or before the time of the Inpatient admission obtain pertinent phone numbers for contacts and establish a maker. J, Cobian we have found that hospitalist admission order sets pdf order set group may have been healthier upon admission to hospital with. Set covers more than 90 percent a our hospitalization acceptances what sizes off a... Our urgent care department, where many of our peculiarity is to vast the no order set group quality and! Whether your patient needs an IV, how many and what sizes we cared for patients with a blank box... Through evidence-based quality improvement and deployment of computerized provider order entry groups in patients with....