Order sets reduce length of stay,
TORONTO – 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
(pictured), 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 1,847 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
healthcare organizations, an approach we believe makes sense in Canadian
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 with 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,
About Grey Bruce Health Network
The Grey Bruce Health Network (GBHN) is a voluntary formal collaboration
of five corporations: Grey Bruce Health Services (6 hospital sites),
Hanover and District Hospital (1 hospital), South Bruce Grey Health
Centre (4 hospital sites), Grey Bruce Health Unit, and the South West
Community Care Access Centre (CCAC). The Spirit and intent of the
Network is to create synergy and collaboration while improving access,
quality, range of programs and services, and promote healthy lifestyles
and the prevention of sickness throughout the counties of Grey and
About Open Source Order Sets
OSOS is a web-enabled, collaborative network of over 90 hospitals in
four provinces. OSOS provides a comprehensive Order Set solution,
including a library of over 380 evidence-based best practice Order Sets,
Order Set project methodology and unlimited project support. OSOS
enables all organizations to share and collaborate together. This
comprehensive approach enables organizations to realize the many
benefits associated with effective Order Set use including improved
quality of care, reduced costs and increased CPOE effectiveness.
For further information: GBHN Order Set Project, Project Lead: Jessica
Meleskie, BSc, MBA, Email:
Open Source Order Sets, Website:
Posted Nov.26, 2009