Using Order Sets Reduces Hospitalization and Medication Errors in COPD

Chronic obstructive pulmonary disease (COPD) patients could spend less time in the hospital if their doctors utilize a checklist of steps called order sets, according to findings published in the Canadian Respiratory Journal.

Researchers from St. Michael’s Hospital in Toronto, Canada examined the effects of order sets on hospital stay time in worsening COPD patients. The study noted that this would assist doctors and other clinicians in choosing the most appropriate care for a patient and improve care quality across several diseases. Additionally, they said that this was the first study of its kind to evaluate the impact of order sets on patients with worsening COPD. The order sets were developed by a team of respiratory and internal medicine researchers at St. Michael’s and provided comprehensive admission instructions for the patients enrolled in the study.

“Using order sets to manage worsening COPD can lead to better medical care and better results for patients,” study leader Samir Gupta explained in a press release. “By providing doctors with the best, evidence based information at the point in time when they are deciding on medications and tests for their patients, we can improve doctors' adherence to best practices.”

When the order sets were used, patients’ length of stay was reduced by about 2.5 days, the researchers found.

“This is a dramatic drop, and points to one of the key, positive findings in our research,” added Gupta, who continued that the faster patients can get home and breathing more easily, the better off both the patients and the health care system are in the long run.

Additionally, the research team determined that order sets increased the rate of patients who were prescribed corticosteroids for the COPD. The patients were not admitted to the intensive care unit because their lung inflammation was under control. The researchers added that more patients received the correct antibiotics, too. The researchers extrapolated this finding and said order sets are able to lead to less over treatment and could even be attributed to less antibiotic resistance.

“At the end of the day, this is all about improving care and outcomes for patients,” said Gupta. “Our next step is to advocate for these order sets to be implemented across the healthcare system, to ensure that these patients receive best evidence based and standardized care.”

Prior research showed that computerized systems reduce medication related ordering errors, whether they are dosing errors, drug interactions, and the like, Gupta concluded. So this study builds on substantial evidence for improvement, he said.