The contribution of sociotechnical factors to health information technology–related sentinel events.
Approach to Improving Safety
- Discontinuities, Gaps, and Hand-Off Problems
- Medication Errors/Preventable Adverse Drug Events
- Wrong-Site Surgery
Setting of Care
This study reviewed sentinel events reported to The Joint Commission between 2010 and 2013 to examine how health information technology (IT) may contribute to serious adverse outcomes. The most frequently identified health IT–related sentinel events were medication errors, wrong-site surgery, and delays in treatment.