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Search results for "General Hospitals"

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Journal Article > Study

Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records.

Walker AS, Mason A, Quan TP, et al. Lancet. 2017 May 9; [Epub ahead of print].

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.

Journal Article > Study

Association between elements of electronic health record systems and the weekend effect in urgent general surgery.

Kothari AN, Brownlee SA, Blackwell RH, et al. JAMA Surg. 2017;152:602-603.

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.

Journal Article > Study

Medication safety in two intensive care units of a community teaching hospital after electronic health record implementation: sociotechnical and human factors engineering considerations.

Carayon P, Wetterneck TB, Cartmill R, et al. J Patient Saf. 2017 Feb 28; [Epub ahead of print].

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.

Journal Article > Study

EHR-related medication errors in two ICUs.

Carayon P, Du S, Brown R, Cartmill R, Johnson M, Wetterneck TB. J Healthc Risk Manag. 2017;36:6-15.

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.

Cases & Commentaries

Lapse in Antibiotics Leads to Sepsis

  • Web M&M

Mitchell Levy, MD; October 2016

Administered antibiotics in the emergency department and rushed to the operating room for emergent cesarean delivery, a pregnant woman was found to have an infection of the amniotic sac. After delivery, she was transferred to the hospital floor without a continuation order for antibiotics. Within 24 hours, the inpatient team realized she had developed septic shock.

Journal Article > Study

Accuracy of laboratory data communication on ICU daily rounds using an electronic health record.

Artis KA, Dyer E, Mohan V, Gold JA. Crit Care Med. 2017;45:179-186.

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.

Journal Article > Commentary

Patient safety in the emergency department.

Farmer BM. Emerg Med. 2016;48:396-404.

Emergency departments are high-risk environments due to the urgency of care needs and complexity of communication. This commentary explores challenges associated with medication administration, handoffs, discharge processes, and electronic health records in emergency medicine and recommends strategies to reduce risks.

Cases & Commentaries

Getting the (Right) Doctor, Right Away

  • Web M&M

Kiran Gupta, MD, MPH, and Raman Khanna, MD; July/August 2016

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.

Journal Article > Study

Frequency of passive EHR alerts in the ICU: another form of alert fatigue?

Kizzier-Carnahan V, Artis KA, Mohan V, Gold JA. J Patient Saf. 2016 Jun 22; [Epub ahead of print].

This study found that laboratory values designated as "abnormal" or "panic" in the electronic health record, which are considered passive alerts, are very common for patients in the intensive care unit. The authors suggest that these passive alerts contribute to the pervasive problem of alert fatigue in the intensive care unit.

Cases & Commentaries

The Case of Mistaken Intubation

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

Maria J. Silveira, MD, MA, MPH; June 2016

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.

Newspaper/Magazine Article

EHRs in the ER: as doctors adapt, concerns emerge about medical errors.

Luthra S. Kaiser Health News. March 1, 2016.

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.

Journal Article > Study

Reduction of incorrect record accessing and charting patient electronic medical records in the perioperative environment.

Rebello E, Kee S, Kowalski A, Harun N, Guindani M, Goravanchi F. Health Informatics J. 2016;22:1055-1062.

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.

Journal Article > Study

Components of hospital perioperative infrastructure can overcome the weekend effect in urgent general surgery procedures.

Kothari AN, Zapf MAC, Blackwell RH, et al. Ann Surg. 2015;262:683-691.

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.

Journal Article > Study

Effect of a real-time pediatric ICU safety bundle dashboard on quality improvement measures.

Shaw SJ, Jacobs B, Stockwell DC, Futterman C, Spaeder MC. Jt Comm J Qual Patient Saf. 2015;41:414-420.

Adherence to quality and safety measures (such as informed consent, presence of urinary catheters, deep venous thrombosis prophylaxis, and medication reconciliation) improved in a pediatric intensive care unit after implementation of an electronic dashboard which displayed real-time data about each of these practices. This study illustrates the importance of providing real-time data to frontline providers as a method to augment adherence to patient safety practices.

Journal Article > Commentary

Ebola US Patient Zero: lessons on misdiagnosis and effective use of electronic health records.

Upadhyay DK, Sittig DF, Singh H. Diagnosis (Berl). 2014;1:283.

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.

Journal Article > Study

Participation in EHR based simulation improves recognition of patient safety issues.

Stephenson LS, Gorsuch A, Hersh WR, Mohan V, Gold JA. BMC Med Educ. 2014;14:224.

In this educational study, medical residents missed patient safety issues in a simulated review of the electronic health record. Repeated simulations resulted in improved but suboptimal performance. These findings support the widespread concern that problems with electronic health record usability lead to patient safety events.

Journal Article > Study

Reducing emergency department charting and ordering errors with a room number watermark on the electronic medical record display.

Yamamoto LG. Hawaii J Med Public Health. 2014;73:322-328.

This survey found that physicians chart or write orders in the wrong patient's electronic health record 1.3% of the time, with significant errors for nurses and clinical assistants as well. Respondents believed that a simple solution such as a prominent room number watermark on the screen would prevent such errors, reinforcing the need to be able to augment electronic health record interfaces to improve safety.

Cases & Commentaries

After-Visit Confusion

  • Web M&M

William Ventres, MD, MA; March 2014

A teenager presented to an urgent care clinic with new bumps and white spots near her tongue. Although she was diagnosed with herpetic gingivostomatitis, the after-visit summary incorrectly populated the diagnosis of "thrush" from the triage information, which was not updated with the correct diagnosis. The mistake on the printout caused confusion for the patient's mother and necessitated several follow-up communications to clear up.

Cases & Commentaries

DRESSed for Failure

  • Web M&M

Erika Abramson, MD, MS, and Rainu Kaushal, MD, MPH; September 2013

After a new electronic health record was introduced without automatically transferring patients' allergy information to the corresponding fields, a woman was given an antibiotic she was allergic to, which resulted in her being admitted to the intensive care unit.

Journal Article > Study

Use of simulation to assess electronic health record safety in the intensive care unit: a pilot study.

March CA, Steiger D, Scholl G, Mohan V, Hersh WR, Gold JA. BMJ Open. 2013;3:e002549.

Residents and fellows frequently failed to identify serious clinical abnormalities when asked to review the electronic medical record (EMR) of a simulated intensive care unit patient, indicating that the design of the EMR may affect situational awareness.

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