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Search results for "Hospitals"

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Journal Article > Review

Nurses' use of computerized clinical guidelines to improve patient safety in hospitals.

Hovde B, Jensen KH, Alexander GL, Fossum M. West J Nurs Res. 2015;37:877-898.

Clinician use of clinical guidelines is known to be less than optimal. According to this review, evidence indicates that nurse utilization of computerized clinical guidelines resulted in care process improvements, but further research is needed to determine if there is a correlation between increased provider access to guidance and patient safety.

Newspaper/Magazine Article

Deep learning is a black box, but health care won't mind.

Brouillette M. MIT Technol Rev. April 27, 2017.

Artificial intelligence can support diagnostic decision-making. This magazine article reports on the use of algorithms to identify dermatologic cancers and highlights progress toward achieving success with these tools.

Journal Article > Study

Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.

Ancker JS, Edwards A, Nosal S, Hauser D, Mauer E, Kaushal R; HITEC Investigators. BMC Med Inform Decis Mak. 2017;17:36.

Alarm fatigue is an increasingly recognized safety concern. This retrospective cohort study found that primary care clinicians were more likely to override alerts when there were multiple alerts per patient, but overrides were not related to overall workload or repeated exposure to the same alert. The authors recommend reducing the number of alerts per patient to address alarm fatigue.

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 > Review

Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis.

Prgomet M, Li L, Niazkhani Z, Georgiou A, Westbrook JI. J Am Med Inform Assoc. 2017;24:413-422.

While prior research has shown that computerized provider order entry and clinical decision support systems have the potential to improve patient safety, less is known about the impact of such systems in intensive care units. In this systematic review and meta-analysis, investigators found an 85% decrease in prescribing errors and a 12% reduction in ICU mortality rates in critical care units that converted from paper orders to commercially available computerized provider order entry systems.

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

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 > Commentary

Clinical decision support for drug related events: moving towards better prevention.

Kane-Gill SL, Achanta A, Kellum JA, Handler SM. World J Crit Care Med. 2016;5:204-211.

Medication administration technologies can help collect data to enhance processes and reduce medication errors. This commentary discusses how organizations are using clinical decision support systems to track problems and incorporating different data sets to prevent adverse drug events.

Journal Article > Study

Comparison of physician and computer diagnostic accuracy.

Semigran HL, Levine DM, Nundy S, Mehrotra A. JAMA Intern Med. 2016;176:1860-1861.

Information technology approaches have been advocated as a means of preventing diagnostic error. This study compared the diagnostic accuracy of computerized symptom checkers (software programs that use diagnostic algorithms based on patients' self-reported symptoms to suggest diagnoses) with that of practicing physicians. Physicians consistently arrived at more accurate diagnoses across a variety of simulated cases.

Journal Article > Review

Effects of health information technology on patient outcomes: a systematic review.

  • Classic

Brenner SK, Kaushal R, Grinspan Z, et al. J Am Med Inform Assoc. 2016;23:1016-1036.

Health information technology (IT) has had a profound impact on health care. Although health IT has led to efficiency gains and improved safety, unintended consequences remain a concern. In this systematic review, researchers analyzed 69 studies from 2001 through 2012 that examined the use of health IT in a clinical setting and its effect on safety outcomes for patients. About one-third of the studies demonstrated a positive impact of health IT on patient safety outcomes, but many of these focused on the hospital setting, involved a single institution, and looked at decision support or computerized provider order entry. The authors suggest that future studies should focus on other areas in which the impact of health IT remains understudied, such as in outpatient and long-term care settings, and they underscore the need for higher quality research. A recent WebM&M commentary described the unintended consequences of health IT.

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.

Web Resource > Government Resource

Attacking the Opioid Crisis Head On With Health IT.

Office of the National Coordinator for Health Information Technology.

Overdoses of opioid medications are considered an epidemic in the United States. This website provides access to various resources for hospitals and clinicians to help them address this patient safety concern. Sections include guidelines, clinical decision support, electronic prescribing, and prescription drug monitoring programs.

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.

Future directions for diagnostic decision support.

Carr S. ImproveDx. April 2016;3:1-3.

Clinical decision support systems are tools being used to augment clinical reasoning and diagnostic accuracy. This newsletter article explores how decision support systems and technology-enhanced consultations can best address gaps in clinician knowledge and improve decision-making behaviors.

Journal Article > Study

Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England.

  • Classic

Cresswell KM, Mozaffar H, Lee L, Williams R, Sheikh A. BMJ Qual Saf. 2017;26:530-541.

Electronic prescribing is an important component of health information technology–related patient safety efforts. Some health care systems have invested in hospital-wide integrated programs that include prescribing modules, whereas others have linked standalone systems through interfacing mechanisms. This intensive study integrated data from six hospitals (including multiple interviews, observations, implementation documents, and expert round-table discussions) to explore the tradeoffs between these technologic strategies. The authors describe various integration and interfacing issues with both standalone and multimodular systems, such as increased workloads due to lack of timely information and insufficient information transfer necessitating manual data entry between modules. A recent PSNet perspective focused on the many advances and remaining challenges of electronic prescribing.

Journal Article > Study

Analysis of clinical decision support system malfunctions: a case series and survey.

Wright A, Hickman TT, McEvoy D, et al. J Am Med Inform Assoc. 2016;23:1068-1076.

Although clinical decision support is a key patient safety strategy, it may also have unintended consequences. Investigators analyzed clinical decision support system malfunctions and surveyed chief medical informatics officers about such incidents. Nearly all health systems experience decision support malfunctions, and the majority of respondents' health systems had at least one within the last 12 months. Detailed examination of several specific cases found that software updates, differences in data fields and codes, unintended enabling and disabling of rules, and technical problems with other systems all resulted in decision support malfunctions. These vulnerabilities often remain undetected and lead to irrelevant or erroneous alerts, which in turn contribute to alert fatigue. The authors suggest that clinical decision support requires more robust testing and monitoring to reach its potential as a patient safety tool.

Journal Article > Study

Impact of errors in paper-based and computerized diabetes management with decision support for hospitalized patients with type 2 diabetes. A post-hoc analysis of a before and after study.

Donsa K, Beck P, Höll B, et al. Int J Med Inform. 2016;90:58-67.

A computerized clinical decision support system for inpatient glucose management resulted in fewer clinically significant episodes of abnormal blood sugars compared to a paper-based system. However, user deviations from the recommended computerized protocol were associated with episodes of hyperglycemia. A WebM&M commentary discusses a case in which misuse of a computerized glucose management system resulted in patient harm.

Journal Article > Study

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting.

Her QL, Amato MG, Seger DL, et al. J Am Med Inform Assoc. 2016;23:924-933.

Users often bypass alerts meant to enhance the safety of medication ordering and dispensing technologies. This observational study at a large academic medical center found approximately one in five nonformulary medication alerts are inappropriately overridden. The authors suggest strategies that future research should examine for improving the design of nonformulary alerts.

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