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Search results for "Hospitals"

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Journal Article > Study

Improving the reliability of verbal communication between primary care physicians and pediatric hospitalists at hospital discharge.

Mussman GM, Vossmeyer MT, Brady PW, Warrick DM, Simmons JM, White CM. J Hosp Med. 2015;10:574-580.

Every day the care of hospital patients is handed off from clinician to clinician, creating serious risks for patient safety. A comprehensive quality improvement program that standardized communication processes and introduced basic electronic health record messaging enhanced the rate of postdischarge verbal handoffs to primary care providers.

Journal Article > Study

Acceptability and feasibility of the Leapfrog computerized physician order entry evaluation tool for hospitals outside the United States.

Cho I, Lee JH, Choi SK, Choi JW, Hwang H, Bates DW. Int J Med Inform. 2015;84:694-701.

Applying the Leapfrog computerized provider order entry evaluation tool to four hospitals in South Korea exposed many opportunities for improvement. Although initially there was concern that national differences in drug prescription patterns might make the tool, which was developed for practices in the United States, unreliable, researchers found sufficient overlap to successfully complete the evaluation.

Journal Article > Study

Development and validation of electronic health record–based triggers to detect delays in follow-up of abnormal lung imaging findings.

Murphy DR, Thomas EJ, Meyer AND, Singh H. Radiology. 2015;277:81-87.

Delays in follow-up of abnormal test results are known to contribute to delayed and missed diagnosis. Investigators developed and validated an electronic trigger to identify potential delays in follow-up of abnormal chest computed tomography scans. This study found that more than half of the flagged cases had a true diagnostic delay. This work should lead to prospective evaluation of trigger approaches to enhance test result follow-up.

Journal Article > Study

We thought we would be perfect: medication errors before and after the initiation of computerized physician order entry.

Schwartzberg D, Ivanovic S, Patel S, Burjonrappa SC. J Surg Res. 2015;198:108-114.

This pre-post study found an increase in medication prescribing errors following the introduction of computerized provider order entry. This work adds to the growing literature about unintended consequences of electronic prescribing, highlighting the need for real-time error detection.

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.

Journal Article > Commentary

Development of an instrument to measure the unintended consequences of EHRs.

Carrington JM, Gephart SM, Verran JA, Finley BA. West J Nurs Res. 2015;37:842-858.

Electronic health records (EHRs) can improve and hinder the safety of care delivery. This commentary describes how existing data was used to develop a tool to measure unintended consequences of EHRs, which can help inform enhancements to EHR implementation.

Journal Article > Study

Evaluating the accuracy of electronic pediatric drug dosing rules.

Kirkendall ES, Spooner SA, Logan JR. J Am Med Inform Assoc. 2014;21:e43-e49.

Comparing the accuracy of electronic dosing rules provided by a commercial vendor with traditional clinical dosing rules in pediatrics, this stimulation study found that the electronic rules were accurate only 55% of the time. This finding highlights the possible unintended consequences of health information technology (IT) on patient safety and underscores the specific challenge of pediatric medication prescribing. A recent AHRQ WebM&M commentary examines the complex issues around medication dosing for pediatric patients.

Journal Article > Study

Active surveillance using electronic triggers to detect adverse events in hospitalized patients.

Szekendi MK, Sullivan C, Bobb A, et al. Qual Saf Health Care. 2006;15:184-190.

This study demonstrated the effective use of an active surveillance methodology designed to improve on current systems that fail to capture events at the time of occurrence. Investigators evaluated more than 325 medical records that were identified based on electronic triggers to develop their method for reviewing adverse events in real time. The authors discuss the large percentage of preventable adverse events that were discovered along with some of the interventions designed to prevent their recurrence. They also discuss how an active surveillance process would improve on existing hospital-wide efforts to promote patient safety.

Journal Article > Study

Reducing warfarin medication interactions: an interrupted time series evaluation.

Feldstein AC, Smith DH, Perrin N, et al. Arch Intern Med. 2006;166:1009-1015.

The authors evaluated the effectiveness of computerized alerts in reducing co-prescribing of warfarin and interacting medications. They found that the alerts had a modest impact on minimizing this potentially dangerous behavior.

Award

22 California hospitals earn top status for outstanding patient safety & health care quality.

San Francisco, CA: The Leapfrog Group; May 2, 2006.

This news release announces that 22 California hospitals have been recognized for their achievements in addressing The Leapfrog Group's standards of quality and safety.

Newspaper/Magazine Article

Study: clinicians copy and paste about half of text in EHR progress notes.

Landi H. Healthcare Informatics. June 1, 2017.

The use of copy and paste is a popular time-saving mechanism to update electronic medical documentation, but this practice can introduce risks. This news article reports on various resources that explore problems associated with the copying and pasting in electronic health records, including a recent study that highlighted how this practice can perpetuate incomplete or wrong information into patient records.

Journal Article > Study

Implications of electronic health record downtime: an analysis of patient safety event reports.

Larsen E, Fong A, Wernz C, Ratwani RM. J Am Med Inform Assoc. 2017 May 30; [Epub ahead of print].

When electronic health records are out of use, either for planned upgrades or because of unexpected malfunction, this downtime disrupts usual hospital workflow. This study conducted an automated text search to identify incident reports related to electronic record downtime and analyzed the selected reports. Electronic health record downtime led to issues with laboratory testing including specimen identification errors and delayed transmission of results. Medication administration errors were also prevalent during downtime. Researchers found that downtime could hinder patient identification and information availability, which may result in serious safety hazards. The authors advocate for development of more comprehensive downtime procedures to address safety concerns as well as more consistent adherence to existing procedures.

Journal Article > Commentary

Emerging from EHR purgatory—moving from process to outcomes.

Goroll AH. N Engl J Med. 2017;376:2004-2006.

Electronic health records can both contribute to and detract from patient safety. This commentary discusses how the physician payment system hinders the development and innovation needed to enhance the ability of electronic health record systems to deliver on promises of improved safety and quality.

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

Incidence of clinically relevant medication errors in the era of electronically prepopulated medication reconciliation forms: a retrospective chart review.

Stockton KR, Wickham ME, Lai S, et al. CMAJ Open. 2017;5:E345-E353.

An accurate list of patient medications is a necessary precursor for safe medication use. One strategy to improve medication reconciliation is to provide a list of dispensed outpatient medications to inpatient clinicians upon hospital admission via an electronic medication reconciliation process. This retrospective chart review study compared a research pharmacist–generated gold standard medication list to the actual medications ordered during an admission after such a process was implemented. The study team identified medication discrepancies between the pharmacist-generated and admission-ordered medication lists and noted any inappropriately prescribed or continued medications. Medication errors were present in nearly half of the patient records; about 9% of errors were clinically important. The authors raise concerns that electronically prepopulated medication reconciliation forms may actually adversely impact medication safety. A previous WebM&M commentary discussed how to enhance accuracy of medication reconciliation.

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

A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites.

Adelman JS, Berger MA, Rai A, et al. J Am Med Inform Assoc. 2017 Apr 17; [Epub ahead of print].

Wrong-patient errors can occur during computerized provider order entry, particularly if ordering clinicians have more than one patient record open. Experts have recommended that health systems allow only a single patient record to be open at a time to prevent these errors. This national survey of electronic health record leaders examined whether health systems permit records for multiple patients to be open simultaneously for electronic ordering and documentation. Nearly 200 health systems responded to the survey, and respondents described widely differing practices. Among health systems where clinicians could open multiple patient records at a time, the common justification was to support efficiency. A significant proportion did impose a restriction of working on one patient record at a time, and a smaller group limited clinicians to working with two open patient records only. These results suggest that further study of the optimal number of open patient records is needed to balance safety and efficiency in completing electronic health record work.

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 > Study

Prescription errors related to the use of computerized provider order-entry system for pediatric patients.

Alhanout K, Bun SS, Retornaz K, Chiche L, Colombini N. Int J Med Inform. 2017;103:15-19.

Computerized provider order entry has been shown to decrease adverse drug events, but it can also introduce new medication errors. This retrospective study examined medication ordering errors intercepted by pharmacists for pediatric patients. As with prior studies in pediatrics, this investigation uncovered dosing errors associated with weight-based dosing, including calculation errors and missing weight information. The most common medication associated with errors was acetaminophen, which can cause severe harm if incorrectly dosed. The authors call for improving electronic health record prescribing interfaces, better user training, and enhancing communication among providers to prevent medication errors.

Journal Article > Study

Analysis of variations in the display of drug names in computerized prescriber-order-entry systems.

Quist AJL, Hickman TT, Amato MG, et al. Am J Health Syst Pharm. 2017;74:499-509.

Evidence suggests that computerized provider order entry (CPOE) systems improve medication safety by mitigating prescribing errors. However, CPOE systems may contribute to errors when user-centered design is not taken into account. In this study, researchers standardized the assessment of 10 distinct inpatient and ambulatory CPOE systems across 6 health care institutions to determine how variation in drug name display may increase the risk of medication errors. Using test patient scenarios, they found significant variation in drug name display, including inconsistencies with regard to the display of brand and generic names. Providers could theoretically prescribe both the brand and generic drug, increasing the risk for patient harm. A recent Annual Perspective discussed the benefits and limitations of CPOE with regard to patient safety.

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