Narrow Results Clear All

Resource Type
Approach to Improving Safety
Safety Target
Setting of Care
Clinical Area
Target Audience
Error Types
Origin/Sponsor

Search results for "Active Errors"

1 - 20 of 67 results
Download Selected Citations

Show: 20 | 50 | 100

Journal Article > Commentary

A learning health care system using computer-aided diagnosis.

Cahan A, Cimino JJ. J Med Internet Res. 2017;19:e54.

Although advanced computing can assist in diagnosis, these systems are not routinely utilized. This commentary suggests a framework to develop diagnostic support technologies that capture physician knowledge to enhance diagnostic safety. The authors encourage drawing from crowdsourced data to guide improvements at a system level to address future practice and educational needs.

Cases & Commentaries

Consequences of Medical Overuse

  • Spotlight Case
  • CME/CEU
  • Web M&M

Daniel J. Morgan, MD, MS, and Andrew Foy, MD; March 2017

Brought to the emergency department from a nursing facility with confusion and generalized weakness, an older woman was found to have an elevated troponin level but no evidence of ischemia on her ECG. A consulting cardiologist recommended treating the patient with three anticoagulants. The next evening, she became acutely confused and a CT scan revealed a large intraparenchymal hemorrhage with a midline shift.

Journal Article > Study

Evaluation of medication-related clinical decision support alert overrides in the intensive care unit.

Wong A, Amato MG, Seger DL, et al. J Crit Care. 2017;39:156-161.

This retrospective study reviewed more than 47,000 overridden medication alerts and found that the vast majority of overrides were clinically appropriate and did not cause harm. From this sample, 7 adverse drug events were identified, and these events were more likely when the alerts were overridden in error. This study demonstrates the challenge of identifying clinically important alerts in a setting where alert fatigue is common.

Journal Article > Study

Diagnostic accuracy of GPs when using an early-intervention decision support system: a high-fidelity simulation.

  • Classic

Kostopoulou O, Porat T, Corrigan D, Mahmoud S, Delaney BC. Br J Gen Pract. 2017;67:e201-e208.

Improving diagnosis in outpatient care is a patient safety priority. This simulation study evaluated the process of diagnosis in the primary care setting. Investigators contrasted physicians' diagnostic accuracy conducting a primary care visit in their usual manner versus using a clinical decision support tool. Each visit employed a standardized patient (an actor reporting symptoms consistent with a given diagnosis) and the visits with and without decision support were matched for complexity. The tool improved diagnostic accuracy significantly: 68% of visits using decision support reached the correct diagnosis versus 59% of usual care visits. The duration of visits and number of subspecialty consultations did not change with or without decision support. Physician participants rated the usability of the decision support tool favorably overall. These data suggest that decision support can be feasibly integrated into primary care to improve diagnostic accuracy.

Journal Article > Study

Clinical reasoning in the context of active decision support during medication prescribing.

Horsky J, Aarts J, Verheul L, Seger DL, van der Sijs H, Bates DW. Int J Med Inform. 2017;97:1-11.

Prior research has shown that providers frequently override drug interaction alerts, sometimes as a result of alert fatigue. In this study, researchers observed providers as they completed medication orders, addressing both high- and low-severity drug interaction alerts using five distinct electronic health records in two countries. The authors found that providers engaged in complex clinical reasoning prior to declining an alert, balancing various aspects of patient care including safety- and patient-specific factors.

Newspaper/Magazine Article

Can computers help doctors reduce diagnostic errors?

Shryock T. Med Econ. December 5, 2016.

Computerized decision support and advanced computing are being used to augment various processes in health care, such as medication ordering and diagnosis. This magazine article reports on the accuracy of these systems and the potential role of artificial intelligence in supporting diagnostic decision making.

Journal Article > Review

Context-sensitive decision support (infobuttons) in electronic health records: a systematic review.

Cook DA, Teixeira MT, Heale BSE, Cimino JJ, Del Fiol G. J Am Med Inform Assoc. 2017;24:460-468.

Infobuttons, a form of clinical decision support, are small icons in the electronic health record that allow users to access online knowledge resources. This systematic review found some evidence that infobuttons may be helpful despite infrequent use. The authors advocate for further research to determine optimal design and implementation of infobuttons in electronic health records.

Journal Article > Study

An observational study to evaluate the usability and intent to adopt an artificial intelligence–powered medication reconciliation tool.

Long J, Yuan MJ, Poonawala R. Interact J Med Res. 2016;5:e14.

This study describes the development of a tablet-based program that includes artificial intelligence elements for guiding patients through medication reconciliation. The researchers observed 10 patients using the tool and collected survey feedback on its usability and value from a small number of physicians, nurses, and patients.

Journal Article > Study

Implementing computerized provider order entry in acute care hospitals in the United States could generate substantial savings to society.

Nuckols TK, Asch SM, Patel V, et al. Jt Comm J Qual Patient Saf. 2015;41:341-350.

Although computerized physician order entry (CPOE) with decision support is considered to be integral to patient safety, high implementation costs and unintended consequences have led to mixed reactions. This cost-utility analysis compared CPOE with paper ordering among patients in acute care hospitals and concluded that CPOE would yield cost savings and improve health outcomes by reducing preventable adverse drug events. The authors noted that high implementation costs, which often exceed prior estimates, significantly decreased the projected cost savings. A related editorial suggests these findings argue conclusively for universal CPOE with decision support, despite the short-term challenges of implementation.

Cases & Commentaries

Anchoring Bias With Critical Implications

  • Spotlight Case
  • CME/CEU
  • Web M&M

Edward Etchells, MD, MSc; June 2015

After multiple visits to both his primary care provider and urgent care for chronic burning left foot pain attributed to peripheral neuropathy, a man presented to the emergency department with worsening symptoms. His left lower leg was dusky and extremely tender, with non-palpable pulses. CT angiography revealed complete blockage of the left superficial femoral artery due to atherosclerotic peripheral arterial disease. The patient required emergent vascular bypass surgery on his left leg, and ultimately, an above-the-knee amputation.

Journal Article > Study

Impact of a warning CPOE system on the inappropriate pill splitting of prescribed medications in outpatients.

Hsu CC, Chou CY, Chou CL, et al. PLoS One. 2014;9:e114359.

Clinicians may prescribe split pills for many different reasons, including dosing flexibility and patient affordability; however, this practice presents potential hazards. Splitting medications that are formulated to be extended-release or enteric-coated can lead to possibly dangerous changes in the drug's functionality. This study discusses the introduction of a clinical decision support warning that created a "hard stop" for any time an outpatient clinician attempted to prescribe a split pill for these special formulation medications. The study site was an academic medical center in Taiwan that performs more than 2.5 million ambulatory visits per year. The intervention resulted in a sharp decline in inappropriate medication splitting from a rate of approximately 0.61% to below 0.2%, where it has remained for at least 10 consecutive months. The use of a hard stop order can be controversial, as this method has resulted in unintended consequences in the past. A prior AHRQ WebM&M perspective discussed some of the tensions related to implementing medication decision support systems.

Journal Article > Review

Hardwiring patient blood management: harnessing information technology to optimize transfusion practice.

Dunbar NM, Szczepiorkowski ZM. Curr Opin Hematol. 2014;21:515-520.

Mistakes during blood transfusion can contribute to patient harm. This review discusses the use of health information technology, such as computerized provider order entry and clinical decision support systems, in transfusion medicine to enhance reliability of ordering practices and enable monitoring of adherence.

Journal Article > Study

Impact of introducing an electronic physiological surveillance system on hospital mortality.

  • Classic

Schmidt PE, Meredith P, Prytherch DR, et al. BMJ Qual Saf. 2015;24:10-20.

Many patients show physiological signs of worsening for several hours prior to requiring more aggressive interventions and transfer to a higher level of care. Rapid response teams have been widely deployed to address this problem, but this approach is fundamentally reactive rather than proactive and has had mixed results so far. This time series study utilized an electronic physiological surveillance system—a real-time decision support system based on patients' vital signs—embedded within the electronic medical record to provide guidance for clinicians in determining patients at risk for deterioration and optimizing treatment intensity. Implementation of the electronic physiological surveillance system was associated with a statistically significant reduction in mortality for a broad range of diagnoses at both hospitals. The results of this study illustrate the potential of novel information technology approaches for prospectively identifying patients at risk for clinical harm.

Journal Article > Commentary

Is it time to move beyond errors in clinical reasoning and discuss accuracy?

Wood TJ. Adv Health Sci Educ Theory Pract. 2014;19:403-407.

Highlighting how heuristics can both increase and reduce risk of diagnostic error, this commentary applies a set of recommended criteria to examine its usefulness in guiding research and augmenting understanding about factors that affect clinical reasoning and support accurate decision making.

Journal Article > Commentary

The ethical imperative to think about thinking.

Stark M, Fins JJ. Camb Q Healthc Ethics. 2014;23:386-396.

This commentary spotlights the importance of learning about cognitive science to understand and improve diagnostic reasoning in order to prevent errors. Underscoring limits of the Hippocratic Oath, the authors describe the ethical responsibility of individuals and organizations to augment clinical decision-making, judgment, and critical thinking skills as an integral component of professionalism.

Journal Article > Review

Safe and appropriate use of insulin and other antihyperglycemic agents in hospital.

Cornish W. Can J Diabetes. 2014;38:94-100.

Insulin is a high-alert medication due to the potential for serious patient harm resulting from inappropriate administration. This review describes tactics to enhance safe insulin use, including improved attention to contraindications, clinical decision support implementation, and education for providers about glycemic control.

Journal Article > Study

Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system.

Woods AD, Mulherin DP, Flynn AJ, Stevenson JG, Zimmerman CR, Chaffee BW. J Am Med Inform Assoc. 2014;21:569-573.

Medical informaticists are still struggling with how to appropriately tailor warnings within computerized provider order entry systems in order to avoid alert fatigue. This preliminary study showed that identifying atypical orders—orders for common medications that differed from providers' previous orders for the same medication—may be a promising way to prevent prescribing errors.

Newspaper/Magazine Article

The biggest mistake doctors make.

Landro L. Wall Street Journal. November 17, 2013.

This newspaper article describes efforts to prevent diagnostic errors, including improving follow-up of abnormal test results and implementing decision support programs.

Special or Theme Issue

Diagnostic Error in Medicine.

Singh H, ed. BMJ Qual Saf. 2013;22(suppl 2):ii1-ii72.

Articles in this special issue cover efforts to reduce diagnostic errors, including patient engagement and cognitive debiasing.

Journal Article > Study

Improving quality and safety of care using "technovigilance": an ethnographic case study of secondary use of data from an electronic prescribing and decision support system.

Dixon-Woods M, Redwood S, Leslie M, Minion J, Martin GP, Coleman JJ. Milbank Q. 2013;91:424-454.

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.

Back to Top