PICU admission order set: a quality improvement initiative in a developing country


  • Muhammad Sartaj Aijaz Pediatric Intensive Care Unit, Sindh Institute of Child Health and Neonatology, Karachi, Sindh, Pakistan https://orcid.org/0009-0008-5650-8897
  • Kiran Shafiq Pediatric Intensive Care Unit, Sindh Institute of Child Health and Neonatology, Karachi, Sindh, Pakistan
  • Urooj Faisal Pediatric Intensive Care Unit, Sindh Institute of Child Health and Neonatology, Karachi, Sindh, Pakistan
  • Arsalan Saeed Pediatric Intensive Care Unit, Sindh Institute of Child Health and Neonatology, Karachi, Sindh, Pakistan
  • Anwarul Haque Pediatric Intensive Care Unit, Sindh Institute of Child Health and Neonatology, Karachi, Sindh, Pakistan




Admission order set, PICU, Implementation


Background: Multiple studies have shown that standardized admission order sets (AOSs) in general as well as specific clinical diseases improved adherence to evidence-based patient management, minimized variability, improved workflow, and augmented patient safety. These order sets are intended to provide a framework for treating patients and planning a course of care. The objective of this study is to assess the implementation of SAOS in a Pediatric Intensive Care Unit (PICU) of a new public-sector hospital in Pakistan.

Methods: A descriptive, cross-sectional study was conducted on all children (age: 1 month to 15 years) admitted to PICU from October to December 2022. All admission orders were paper-written based on the mnemonic "AD CAVA DIMPLS". All data were collected on Microsoft Excel and descriptive statistics were applied.

Results: A total of 932 admissions were done during the first three months. The most common age and admitting diagnosis were one-year-old and lower respiratory tract diseases respectively. The overall adherence to AOS was 71.68%. Nine components of AOS [AD CAVA DIM] had 90.77% appropriate utilization.

Conclusions: We observed a very high rate of implementation of AOS in our PICU.


Plsek PE. Quality improvement methods in clinical medicine. Pediatrics. 1999;103(Supplement_E1):203-14.

De Jonge V, Nicolaas JS, van Leerdam ME, Kuipers EJ. Overview of the quality assurance movement in health care. Best Pract Res Clin Gastroenterol. 2011;25(3):337-47.

Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care. 2007;16:2-3.

Bartman T, Brilli RJ. Quality improvement studies in pediatric critical care medicine. Pediatr Crit Care Med. 2021;22(7):662-8.

Curtis JR, Cook DJ, Wall RJ, Angus DC, Bion J, Kacmarek R, et al. Intensive care unit quality improvement: A “how-to” guide for the interdisciplinary team. Crit Care Med. 2006;34(1):211-8.

Kourtis SA, Burns JP. Quality improvement in pediatric intensive care: a systematic review of the literature. Pediatr Investig. 2019;3(02):110-6.

Maslove DM, Rizk N, Lowe HJ. Computerized physician order entry in the critical care environment: a review of current literature. J Intensive Care Med. 2011;26(3):165-71.

Chisolm DJ, McAlearney AS, Veneris S, Fisher D, Holtzlander M, McCoy KS. The role of computerized order sets in pediatric inpatient asthma treatment. Pediatr Allergy Immunol. 2006;17(3):199-206.

Bekmezian A, Chung PJ, Yazdani S. Standardized admission order set improves perceived quality of pediatric inpatient care. J Hosp Med. 2009;4(2):90-6.

Grissinger M. Guidelines for standard order sets. P. T. 2014;39(1):10.

Micek ST, Roubinian N, Heuring T, Bode M, Williams J, Harrison C, et al. Before–after study of a standardized hospital order set for the management of septic shock. Crit Care Med. 2006;34(11):2707-13.

Dayal A, Alvarez F. The effect of implementation of standardized, evidence-based order sets on efficiency and quality measures for pediatric respiratory illnesses in a community hospital. Hosp Pediatr. 2015;5(12):624-9.

Fleming NS, Ogola G, Ballard DJ. Implementing a standardized order set for community-acquired pneumonia: impact on mortality and cost. Jt Comm J Qual Patient Saf. 2009;35(8):414-21.

Muniga ET, Walroth TA, Washburn NC. The impact of changes to an electronic admission order set on prescribing and clinical outcomes in the intensive care unit. Appl Clin Inform. 2020;11(01):182-9.

Johnson CD, Zeiger RF, Das AK, Goldstein MK. Task analysis of writing hospital admission orders: evidence of a problem-based approach. AMIA Annu Symp Proc. 2006: 389-93.

McAlearney AS, Chisolm D, Veneris S, Rich D, Kelleher K. Utilization of evidence-based computerized order sets in pediatrics. Int J Med Inform. 2006;75(7):501-12.

Munasinghe RL, Arsene C, Abraham TK, Zidan M, Siddique M. Improving the utilization of admission order sets in a computerized physician order entry system by integrating modular disease-specific order subsets into a general medicine admission order set. J Am Med Inform Assoc. 2011;18(3):322-6.

Eslami S, de Keizer NF, Abu-Hanna A. The impact of computerized physician medication order entry in hospitalized patients-a systematic review. Int J Med Inform. 2008;77(6):365-76.

Blunden C, Walsh Koricke M. Creating a Standardized Order Set for DKA Admissions to the PICU. Am J Med Qual. 2016;31(1):93-.

Pendharkar SR, Ospina MB, Southern DA, Hirani N, Graham J, Faris P, et al. Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease. BMC Pulmonary Medicine. 2018;18:1-8.

Abrahamyan L, Austin PC, Donovan LR, Tu JV. Standard admission orders can improve the management of acute myocardial infarction. International Journal for Quality in Health Care. 2012;24(4):425-32.

O'Connor C, DeCaire K, Friedrich J (editors). Improving patient care through the use of evidence-based order sets. AMIA annual symposium proceedings; American Medical Informatics Association; 2005.

Sellers ZM, Dike C, Zhang KY, Giefer MJ, Uc A, Abu-El-Haija M. A unified treatment algorithm and admission order set for pediatric acute pancreatitis. Journal of pediatric gastroenterology and nutrition. 2019;68(6):e109-e11.






Original Research Articles