{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:58:50Z","timestamp":1791583130245,"version":"4.3.4"},"reference-count":14,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Emergency-to\u2013intensive care unit (ICU) admissions are high-stakes transitions in care, where delays or documentation errors can compromise patient safety and disrupt operational efficiency. Although digital order systems can support these workflows, traditional platforms often lack real-time traceability and structured input logic, leaving them vulnerable to duplicate submissions, lost orders, and misaligned ICU bed reservations.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The study aimed to examine whether an updated digital order system was associated with differences in emergency-to-ICU admission workflows, including order validity, documentation-error frequencies, and ICU reservation alignment, compared with those of the traditional platform.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a single-center retrospective historical-control formative evaluation of emergency-to-ICU admissions processed through traditional (2023) and updated (2024) digital order systems at a tertiary medical center. Prospectively generated system log and ICU-reservation data were analyzed to quantify order validity, error subtypes (duplicate, lost, and tracking), and admission-to-reservation alignment. Proportions were compared using chi-square tests, with risk ratios (RRs) and absolute differences in proportions reported. Statistical significance was defined as\n P<\/jats:italic>\n <.05.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The updated system was associated with higher admission-order validity (54.1%-75.4%; RR 1.39, 95% CI 1.25\u20101.54;\n P<\/jats:italic>\n <.001) and lower erroneous-order frequency (45.9%-24.6%; RR 0.54, 95% CI 0.44\u20100.66;\n P<\/jats:italic>\n <.001). Duplicate and lost orders declined, whereas tracking-error frequency showed no meaningful change. ICU reservation alignment also differed, with the admission-to-reservation ratio rising from 0.68 to 0.78 (RR 0.88, 95% CI 0.77-0.99;\n P<\/jats:italic>\n =.03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The updated digital order system was associated with more consistent emergency-to-ICU workflow patterns, including higher order validity, fewer documentation errors, and closer alignment between admission intent and ICU reservations. These findings are consistent with literature on structured electronic order systems, digital-workflow standardization, and timestamp integrity, and they highlight the potential value of structured, timestamp-driven digital infrastructures in supporting more reliable high-acuity workflows. Further evaluation using time-motion analysis, interaction-log metrics, or mixed methods assessment is warranted to examine the robustness and generalizability of these patterns.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/88230","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:44:26Z","timestamp":1791582266000},"page":"e88230-e88230","source":"Crossref","is-referenced-by-count":0,"title":["Digital Order System Redesign in Emergency-to\u2013Intensive Care Unit Admissions: Prospective Observational Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5283-9850","authenticated-orcid":false,"given":"Ding-Kuo","family":"Chien","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8179-0486","authenticated-orcid":false,"given":"Wei Hung","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8345-7038","authenticated-orcid":false,"given":"Chih Wei","family":"Ten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4567-1014","authenticated-orcid":false,"given":"Jung-Mei","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2560-8480","authenticated-orcid":false,"given":"Li-Kuo","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0127-230X","authenticated-orcid":false,"given":"Shih-Yi","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","DOI":"10.1186\/cc9975","article-title":"Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study","volume":"15","author":"Cardoso","journal-title":"Crit Care"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-13343-y","article-title":"Implementation of a digital coordination centre in a hospital: a qualitative evaluation of enablers, barriers and strategies","volume":"25","author":"Shaw","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"R3","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1111\/1475-6773.14076","article-title":"Association of emergency department crowding with inpatient outcomes","volume":"58","author":"Hsuan","journal-title":"Health Serv Res"},{"issue":"12","key":"R4","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1097\/CCM.0000000000006396","article-title":"Emergency department triage, transfer times, and hospital mortality of patients admitted to the ICU: a retrospective replication and continuation study","volume":"52","author":"van Herwerden","journal-title":"Crit Care Med"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1007\/s44231-023-00036-5","article-title":"Intelligent intensive care unit: current and future trends","volume":"3","author":"Mao","journal-title":"Intensive Care Res"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.im.2017.04.001","article-title":"An integrated big data analytics-enabled transformation model: application to health care","volume":"55","author":"Wang","journal-title":"Inf Manag"},{"key":"R7","doi-asserted-by":"crossref","unstructured":"Zhang Z Luo X Harris R George S Finkelstein J . Hands-free electronic documentation in emergency care work through smart glasses. In: Smits M , editor. Information for a Better World: Shaping the Global Future: 17th International Conference, iConference 2022, Virtual Event, February 28 \u2013 March 4, 2022, Proceedings, Part II. Springer; 2022:314-331. [doi: 10.1007\/978-3-030-96960-8_21]","DOI":"10.1007\/978-3-030-96960-8_21"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1186\/s40537-025-01197-4","article-title":"A unified IoT architectural model for smart hospitals: enhancing interoperability, security, and efficiency through clinical information systems (CIS)","volume":"12","author":"Yadegari","journal-title":"J Big Data"},{"key":"R9","unstructured":"Emergency response: the digital age of emergency medicine. Panasonic Connect; 2025. URL: https:\/\/eu.connect.panasonic.com\/gb\/en\/whitepapers\/emergency-response-digital-age-emergency-medicine [Accessed 14-08-2026]"},{"issue":"12","key":"R10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.16499","article-title":"Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system","volume":"2","author":"Horng","journal-title":"JAMA Netw Open"},{"issue":"5","key":"R11","doi-asserted-by":"publisher","first-page":"210","DOI":"10.3390\/fi17050210","article-title":"A blockchain-based strategy for certifying timestamps in a distributed healthcare emergency response systems","volume":"17","author":"Marletta","journal-title":"Future Internet"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.2196\/54572","article-title":"The effects of electronic health records on medical error reduction: extension of the DeLone and McLean information system success model","volume":"12","author":"Chimbo","journal-title":"JMIR Med Inform"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1287\/isre.3.1.60","article-title":"Information systems success: the quest for the dependent variable","volume":"3","author":"DeLone","journal-title":"Inf Syst Res"},{"issue":"4","key":"R14","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1080\/07421222.2003.11045748","article-title":"The DeLone and McLean model of information systems success: a ten-year update","volume":"19","author":"DeLone","journal-title":"J Manag Inf Syst"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:44:27Z","timestamp":1791582267000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e88230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":14,"URL":"https:\/\/doi.org\/10.2196\/88230","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"v10i1e88230"}}