Search results for "Electronic Health Records"

The weekend effect (higher mortality for patients in acute care settings on weekends compared to weekdays) has led to widespread concerns about hospital staffing. This retrospective study examined whether mortality for emergency admissions at four hospitals in the United Kingdom differed on weekends compared to weekdays. Unlike prior studies of the weekend effect, this study included multiple specific markers of patients' illness severity as well as hospital workload. Investigators found higher mortality associated with being admitted to the hospital during weekends compared to weekdays, but a significant proportion of the observed weekend effect was explained by severity of patient illness. They used three measures to approximate hospital workload: total number of admissions, net admissions (subtracting discharges from admissions), and percentage of beds occupied. None of these workload measures was associated with mortality. The authors conclude that differences in illness severity rather than health care team staffing explain the weekend effect. A recent PSNet interview discussed the weekend effect in health care.

This statewide, retrospective cross-sectional study identified longer than expected length of stay for urgent surgical procedures on the weekend compared to weekdays. Hospitals with electronic operating room scheduling and electronic bed management systems were less likely to demonstrate the weekend effect. These results suggest that health information technology can be employed to mitigate the weekend effect.

This human factors study examined how electronic health record (EHR) implementation affected medication safety. Researchers encountered improvements in transcription, dispensing, and administration errors after EHR introduction. Several types of medication prescribing errors, including choosing the wrong drug, duplicate orders, or orders with incorrect information, increased with EHR use. This study adds to the evidence suggesting EHR implementation has mixed effects on medication safety.

Despite the demonstrated success of technology in reducing medication errors, preventable adverse drug events remain a significant source of harm to patients. Researchers analyzed data on medication safety events in 2 ICUs at a medical center and found 1622 preventable adverse drug events among 624 patients. About one third of these events were related to electronic health record use, including duplicate orders.

Information provided at bedside rounds is critical for clinical decision-making in inpatient settings. This direct observation study found that laboratory data reported at rounds is prone to error, most often omissions. The authors suggest that inaccurately communicated laboratory data is a prevalent and underrecognized patient safety concern.

A woman with a history of chronic obstructive pulmonary disease underwent hip surgery and experienced shortness of breath postoperatively. A chest radiograph showed a pneumothorax, but the radiologist was unable to locate the first call physician to page about this critical finding.

An older man with multiple medical conditions was found hypoxic, hypotensive, and tachycardic. He was taken to the hospital. Providers there were unable to determine the patient's wishes for life-sustaining care, and, unaware that he had previously completed a DNR/DNI order, they placed him on a mechanical ventilator.

Many emergency departments have recently implemented electronic health records, which has introduced new safety hazards. This news article reports on challenges associated with the growing use of electronic health records in emergency care, including insufficient usability and increased risk of documentation errors.

This electronic audit study examined the incidence of opening and charting in the wrong patient record in the perioperative period. Investigators observed that this error declined over time. They attribute this improvement to time-out procedures and barcoding, both of which facilitate patient identification.

The weekend effect is a well-documented phenomenon where patients admitted over the weekend have inferior outcomes compared to those admitted on a weekday. This retrospective study utilized the AHRQ Healthcare Cost and Utilization Project database and found that specific factors, such as full adoption of electronic health records, home health programs, and increased nurse-to-bed ratios, were associated with overcoming the weekend effect in hospitals.

Misdiagnosis and errors linked to electronic health records (EHRs) are common concerns in patient safety. This commentary examines these elements in the context of the first Ebola case in the United States to reveal weaknesses in emergency department care, disaster management, and diagnostic processes. The case analysis highlights challenges associated with forming diagnoses and the usability of EHRs as decision support tools.

As they become more prevalent, electronic medical records (EMRs) are being used to improve safety in increasingly creative ways. Recent studies have shown that EMRs can be used to detect diagnostic errors and postoperative complications with accuracy. In this study, the investigators developed an automated method for detecting unapproved abbreviations (UAAs) within clinicians' notes, measured the incidence of UAAs over time, and fed back data to individual clinicians on their use of UAAs. This system resulted in a significant reduction in the use of UAAs over the 6-month study period. Since using UAAs is common and has been linked to serious adverse events, this study demonstrates another potential use of EMRs to improve patient safety.

Achieving medication reconciliation continues to present significant challenges, despite existing guidelines and its demonstrated impact on patient safety. Electronic health records (EHRs) and related tools have long been touted as solutions to bolster reconciliation safety. This study evaluated whether an EHR shared between outpatient and inpatient providers could reduce suspected medication discrepancies. Although errors were reduced, significant discrepancies persisted among various forms of reconciliation, including differences between what was in the record and what patients actually reported taking. Problems included outdated or incomplete medication information, incorrect information provided by patients, or mismatched information between the different sources. The authors argue that EHRs, as an added information vehicle, may help reduce reconciliation errors, but they caution that EHRs are only a tool (and not in themselves a solution) for safer reconciliation. A past AHRQ WebM&M commentary discussed whose job it is to assure safe medication reconciliation.

By enhancing providers' ability to transmit information in a concise and standardized fashion, electronic medical records (EMR) offer great promise for improving handoffs and signouts. However, this analysis of nursing handoffs at an institution with a commercial EMR found that the built-in patient summaries provided inadequate detail and flexibility for clinical signout purposes, forcing nurses to develop workarounds for transmitting key information. This finding reveals the importance of human factors engineering in designing information technology solutions for patient safety problems.

Many adverse event identification methods cannot detect errors until well after the event has occurred, as they rely on screening administrative data or review of the entire chart after discharge. Electronic medical records (EMRs) offer several potential patient safety advantages, such as decision support for averting medication or diagnostic errors. This study, conducted in the Veterans Affairs system, reports on the successful development of algorithms for screening clinicians' notes within EMRs to detect postoperative complications. The algorithms accurately identified a range of postoperative adverse events, with a lower false negative rate than the Patient Safety Indicators. As the accompanying editorial notes, these results extend the patient safety possibilities of EMRs to potentially allow for real time identification of adverse events.

The design of electronic medical record (EMR) interfaces according to human factors engineering principles is crucial to ensuring clinicians' ability to access and process data rapidly. This usability study compared a custom-designed interface with a standard off-the-shelf EMR, and found that intensive care unit physicians were able to complete patient care tasks rapidly and with greater accuracy using an interface designed with provider workflow in mind.

This study found that ICU nurses were more accepting of electronic health records (EHR) at 12 months after implementation compared to 3, and this acceptance was predicted by EHR usability and computerized provider order entry usefulness.

This study demonstrated the utility of trigger tools to detect adverse events related to outpatient surgery. Venous thromboembolic events and emergency department triggers appeared the most promising to identify and drive improvements.

This case report discusses one hospital's implementation of an inpatient electronic health record with computerized provider order entry, and how it resulted in rapid improvement of cost and safety measures.

Describing the experience of one hospital's implementation of an electronic system to help track and manage tests pending at hospital discharge, this study describes the surprisingly large number of barriers to developing safe and effective systems to deal with such tests at discharge.