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Journal Article > Study
Effect of restriction of the number of concurrently open records in an electronic health record on wrong-patient order errors: a randomized clinical trial.
Adelman JS, Applebaum JR, Schechter CB, et al. JAMA. 2019;321:1780-1787.
Having multiple patient records open in the electronic health record increases the potential risk of wrong-patient actions. This randomized trial tested two different electronic health record configurations: one allowed up to four patient records to be open at a time, and the other allowed only one to be open. Among the 3356 clinicians with nearly 4.5 million order sessions, there were no significant differences in wrong-patient orders. However, the investigators noted that clinicians in the multiple records group placed most orders with just one record open. A post hoc analysis determined that the rate of errors increased when orders were placed with multiple records open. A related editorial highlights the tradeoffs between safety and efficiency and argues for examining the context of the two configurations, including throughput and clinician satisfaction. A previous PSNet perspective discussed assessing and improving the safety of electronic health records.
Journal Article > Study
Challenges of making a diagnosis in the outpatient setting: a multi-site survey of primary care physicians.
Sarkar U, Bonacum D, Strull W, et al. BMJ Qual Saf. 2012;21:641-648.
Diagnostic errors have been deemed the "next frontier" in patient safety based on studies suggesting their significant contribution to patient harm. While prevention strategies have focused on the acute care setting, equal concern about diagnostic errors is warranted in primary care practices. This multicenter study surveyed more than 1000 primary care physicians who reported that more than 5% of their patients were difficult to diagnose. Inadequate knowledge was the most commonly reported cognitive factor, with more experienced physicians reporting less diagnostic difficulty. Addressing workload issues, such as panel size and non-visit tasks, was the most common improvement strategy. The authors discuss both system- and practice-level initiatives that may reduce diagnostic difficulties, including allowing more time to process diagnostic information and facilitating better subspecialty input. A past AHRQ WebM&M perspective and interview discuss diagnostic errors.