Standardized Orders Improve Pediatric Care

AbstractBACKGROUND:Few studies exist on the ability of standardized preprinted order forms to improve patient care.OBJECTIVE:To examine resident‐perceived effects of introducing a pediatric admission order set (PAOS) on the quality of inpatient care.DESIGN:Cross‐sectional study.SETTING:University of California, Los Angeles (UCLA) Children's Hospital, a nonprofit, tertiary‐care teaching hospital and major referral center with approximately 3,000 admissions per year.PARTICIPANTS:A total of 97 pediatric residents (PL‐1, n = 34; PL‐2, n = 33; and PL‐3, n = 30) who did the vast majority of the inpatient admissions.MEASUREMENTS:Residents were asked to rate the PAOS overall and with respect to 9 specific dimensions using a 5‐point Likert scale.RESULTS:Overall, 89% of respondents approved of the PAOS, 58% reported using it ≥90% of the time, and all said that they would recommend it to their colleagues. Eighty‐four percent thought that it improved inpatient care, and 75% thought that medical errors were reduced. Eighty‐eight percent reported that the PAOS saved time; 93% said it was convenient; and most reported less need for clarification with secretaries (81%) and nurses (82%). In multivariate regression analyses, the only predictor of overall rating was whether the PAOS improved inpatient care (P = 0.04). Improved patient care, meanwhile, was predicted by whether the PAOS was comprehensive (P = 0.01), reduced medical errors (P = 0.01), and required less clarification with nurses (P = 0.01).CONCLUSIONS: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. Journal of Hospital Medicine 2009;4:90–96. ？ 2009 Society of Hospital Medicine