Study of GBHN Order Set project reveals improvements in the length of stay and ordering of best practices

A study of the Grey Bruce Health Network (GBHN) Order Set project has revealed impressive improvements in the length of stay and ordering of best practices.

The GBHN Order Set Project began in March 2007 when GBHN partnered with the Open Source Order Set Network (OSOS) to standardize and improve care across the 11 hospitals of the GBHN Network. Since then GBHN has been able to develop and implement over 100 evidence based best practice order sets in all areas of patient care.

Order Sets are treatment templates used to generate orders for patients. When used to admit patients to hospital, Order Sets had the following benefits (compared to patients admitted without an Order Set):

- Reduced Length of Stay: length of stay was reduced by almost one full day (from 5.84 to 4.88 days) - Reduced Readmissions: unscheduled readmissions during the first week of discharge were reduced by almost 50% - Improved Quality: ordering of over 100 best practice medications, investigations, consults and treatments was improved

"We are very excited about these results" says Jessica Meleskie, lead of the GBHN Order Set project "Improved quality and reduced resource utilization- the GBHN Order Set project has created a durable foundation for sustained quality improvement in a very cost effective way. Our Order Set project is a key success factor for our computerized physician order entry project (CPOE) and we plan to continue to develop the use of Order Sets at GBHN."

The study reviewed 1847 charts from February 2008 to February 2009. Ten areas of care were examined - acute coronary syndrome, caesarean section, COPD, congestive heart failure, pneumonia, febrile neutopenia, fractured hip, stroke, hip replacement, vaginal birth - and include all hospitals from across GBHN.

"All organizations, over 90 hospitals on the OSOS Network, will be able to benefit from the excellent work done by GBHN" says Kathy De Caire RN(EC). "The OSOS Network enables sharing and collaboration between health care organizations, an approach we believe makes sense in Canadian health care"

Order sets improved the ordering of many key quality aspects of care, often dramatically increasing the use of evidence-based best practices. For example, the use of acetylsalicylic acid (ASA) chewable tablets is known to reduce the chance of death when administered to patients with acute coronary syndrome (heart attack). The Grey Bruce audit showed that physicians using order sets were 143% more likely to order ASA using an order set compared to patients admitted without an Order Set.

This audit highlights the positive and critical impact that order sets have on the quality and cost of caring for patients in Grey Bruce, Ontario.