Impact Of Cpoe On Workflow And Direct Patient Care Time In An Inpatient Hematology/Oncology Service.

6142 Background: Few data exist on the impact of computerized prescriber order entry (CPOE) on the workflow of inpatient leukemia and lymphoma care, yet concerns exist that CPOE use could cause increased work and changes in standard workflow for clinicians. Methods: We conducted a direct observation time and motion study pre- and postimplementation of a commercial CPOE system on an inpatient hematology/oncology (H/O) service at a large, regional medical center. We studied the work patterns of physician assistants (PAs) who consistently worked under the supervision of faculty physicians and entered all orders except chemotherapy. Data were recorded on a tablet computer with a data entry tool containing 63 individual activity categories that were further grouped into 12 analysis categories. Observations were made at −1, +3, and +8 months post-implementation, totaling 228 hours. Data were normalized to account for varying census levels. Results: Mean patient census was 11.3 per day at -1 months, 9.2 at +3 months and 6.4 at +8 months postimplementation. Overall percent time spent on order-related activities was unchanged, with 10.2% at -1, 10.6% at +3, and 11.4% at +8 months. Percent time spent on direct patient care activities was also unchanged: 50.7% at -1, 49.8% at +3, and 47.8% at +8 months. We also analyzed the data for differences in consecutive sequential patterns. The most common 3-sequence pattern (talking/rounding –> walking/moving –> talking/rounding) was identical in all 3 observation periods, suggesting that CPOE did not drastically change the flow of the work for the H/O service. The total number of alphanumeric pages received by the PAs, used as a proxy for order clarifications, was 119 at -1, 25 at +3, and 17 at +8 months. Conclusions: Our results suggest that CPOE use in a busy H/O inpatient service has minimal impact on time and workflow for trained PAs at 3 and 8 months after CPOE implementation, and reduced the number of pages needed for order clarification. More research is needed to determine if using CPOE for hematology patients may result in a change in the quality of patient care or safety. No significant financial relationships to disclose.