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A Randomized Trial

Paul R. Dexter, MD; Susan M. Perkins, PhD; Kati S. Maharry, MAS; Kathy Jones, MD; Clement J. McDonald, MD

JAMA. 2004;292:2366-2371.

Context  Computerized reminder systems increase influenza and pneumococcal vaccination rates, but computerized standing order systems have not been previously described or evaluated.

Objective  To determine the effects of computerized physician standing orders compared with physician reminders on inpatient vaccination rates.

Design, Setting, and Patients  Randomized trial of 3777 general medicine patients discharged from 1 of 6 study wards during a 14-month period (November 1, 1998, through December 31, 1999) composed of 2 overlapping influenza seasons at an urban public teaching hospital.

Interventions  The hospital’s computerized physician order entry system identified inpatients eligible for influenza and pneumococcal vaccination. For patients with standing orders, the system automatically produced vaccine orders directed to nurses at the time of patient discharge. For patients with reminders, the computer system provided reminders to physicians that included vaccine orders during routine order entry sessions.

Main Outcome Measure  Vaccine administration.

Results  During the approximately 6 months of the influenza season, 50% of all hospitalized patients were identified as eligible for influenza vaccination. Twenty-two percent of patients hospitalized during the entire 14 months of the study were found eligible for pneumococcal vaccination. Patients with standing orders received an influenza vaccine significantly more often (42%) than those patients with reminders (30%) (P <.001). Patients with standing orders received a pneumococcal vaccine significantly more often (51%) than those with reminders (31%) (P <.001).

Conclusions  Computerized standing orders were more effective than computerized reminders for increasing both influenza and pneumococcal vaccine administration. Our findings suggest that computerized standing orders should be used more widely for this purpose.

Author Affiliations: Department of Medicine, Wishard Memorial Hospital and Indiana University School of Medicine, Indianapolis (Drs Dexter, Perkins, Jones, McDonald, and Ms Maharry); Regenstrief Institute for Health Care, Indianapolis, Ind (Drs Dexter, Perkins, and McDonald); and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Ind (Dr Dexter).

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