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Alert fatigue is a known contributor to medical error. In this cross-sectional study, researchers found that custom alerts were responsible for the majority of alert burden at six pediatric health systems. This study also compared the use of different alert burden metrics to benchmark burden across and within institutions.

This article describes the development and implementation of a digital tool to centralize and standardize COVID-19-related resources for use in the emergency department (ED). Clinician feedback suggests confirms that the tool has affected their management of COVID-19 patients. The tool was found to be easily adaptable to accommodate rapidly evolving guidance and enable organizational capacity for improvisation and resiliency.  

This article describes the implementation of the Enhancing Quality of Prescribing Practices for Older Adults in the Emergency Department (EQUIPPED) medication safety program at three academic medical centers. EQUIPPED is a multicomponent intervention intended to reduce potentially inappropriate prescribing among adults aged 65 and older who are discharged from the Emergency Department. The authors discuss lessons learned and provide insight which can inform implementation strategies at other institutions.

This study evaluated the impact of an electronic decision support tool comprising a comprehensive drug review to support deprescribing and reduce polypharmacy in elderly adults. Results indicate that the tool did reduce the number of prescribed drugs but did not significantly reduce unplanned hospital admissions or death after 24 months.

The authors discuss the challenges social inequalities pose to machine learning models, provide several recommendations for adopting ethical principles for the delivery of machine learning-assisted health care.

This study describes a multi-disciplinary quality improvement project aimed at increasing the percentage of completed medication reconciliations upon admission. Interventions included EHR workflow redesigns, provider training, and performance data reporting. After seven months, the project resulted in an increase in medication reconciliation at admission, and a higher percentage of medication reconciled across drug classes, including high-alert drugs.

Cascades of care (or follow up) on incidental findings from diagnostic tests are common but are not always clinically meaningful. This study reports the results of a nationally representative group of physicians who were surveyed on their experiences with cascades. Almost all respondents had experienced cascades and many reported harms to patients and personal frustration and anxiety that may contribute to physician burnout.

Ethnographic observations and semi-structured interview data showed that implementation of an electronic health record with prescribing and decision support led to greater oversight of and improvements in specific safety metrics.

Accurate initial assessment and resuscitation of trauma patients is critical to ensuring correct treatment and survival, and although standardized algorithms have been developed for initial trauma evaluation, errors are not uncommon. This innovative randomized controlled trial implemented a computerized clinician decision support system (CDSS) to ensure adherence to standardized protocols for trauma resuscitation, and used video capture of trauma resuscitations to assess the effects of the CDSS on patient outcomes. Use of the CDSS resulted in significantly reduced errors, and also reduced morbidity compared to standard treatment. This study demonstrates the utility of a CDSS in a fast-paced, high-acuity environment.

This article discusses how several health care organizations used health information technology to improve organizational transparency.

While most research on computerized provider order entry (CPOE) has focused on its role in preventing medication errors, CPOE—especially when combined with decision support—also has the potential to improve the quality and efficiency of care. This systematic review found that decision support systems (DSS) within CPOE increased adherence to radiology test ordering guidelines, resulting in an overall decrease in radiology utilization. These findings have the potential to improve patient safety as well, given the concern that unnecessary imaging studies may expose patients to dangerous levels of radiation. Prior studies have also shown that combining CPOE with DSS can improve diagnostic performance and encourage appropriate use of prophylactic medications.

This review reveals how decision support systems can assist error reduction efforts and discusses key design and implementation issues.

This commentary describes a process structured around improving safety culture and promoting use of technology to enhance patient safety.

Computerized provider order entry (CPOE) has provided significant safety benefits in research studies, especially when combined with clinical decision support to prevent common prescribing errors. However, CPOE's "real-world" performance has been mixed, with high-profile studies documenting a variety of unintended consequences. This AHRQ-funded study used simulated patient records to evaluate the ability of eight commercial CPOE modules to prevent medication errors. The overall results were disappointing, as CPOE failed to prevent many medication errors—including fully half of potentially fatal errors, which are considered never events. The individual CPOE products varied significantly in their ability to detect potential errors. Some hospitals did achieve superior performance, which the authors ascribe to greater experience with CPOE and implementation of more advanced decision support tools. Another recent article found that reminders within CPOE systems resulted in only small improvements in adherence to recommended care processes. Taken together, these studies imply that CPOE implementation may not result in large immediate effects on safety and quality in typical practice settings.

This AHRQ-funded study found that physicians usually chose appropriate reasons for excluding patients from inclusion in quality measurement programs.