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Search results for "Information Professionals"

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Journal Article > Commentary

Health information exchange in emergency medicine.

Shapiro JS, Crowley D, Hoxhaj S, et al. Ann Emerg Med. 2016;67:216-226.

Insufficient access to patient information in the emergency department can result in patient harm. This commentary explores health information exchange systems, which provide clinicians with access to patient health information across multiple sources to enable continuity of care, in emergency medicine and offers recommendations to enhance the sharing of data to augment patient safety.

Journal Article > Study

Interruptions in a level one trauma center: a case study.

Brixey JJ, Tang Z, Robinson DJ, et al. Int J Med Inform. 2008;77:235-241.

The investigators shadowed emergency department nurses and physicians and identified the types of interruptions that occurred and what factors contributed to them.

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.

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.

Journal Article > Study

Incidence of speech recognition errors in the emergency department.

Goss FR, Zhou L, Weiner SG. Int J Med Inform. 2016;93:70-73.

The adoption of new technology in health care often produces unintended consequences, which can be mitigated by applying human factors engineering principles to user interface design. Due to efficiency gains, the use of speech recognition technology among physicians has grown in recent years. Investigators analyzed notes dictated by emergency medicine physicians and found that 71% of the notes contained errors. Given that 15% of the errors were considered critical, the authors suggest speech recognition technology may create miscommunication that could adversely affect patient care.

Journal Article > Study

Can medical record reviewers reliably identify errors and adverse events in the ED?

Klasco RS, Wolfe RE, Lee T, et al. Am J Emerg Med. 2016;34:1043-1048.

Classic studies of the epidemiology of adverse events in hospitalized patients have identified safety issues using retrospective chart review combined with trigger tools. This study examined this methodology to detect adverse events in emergency department patients and found good agreement between independent clinical reviewers regarding the presence of errors and adverse events.

Journal Article > Study

Electronic prescription writing errors in the pediatric emergency department.

Nelson CE, Selbst SM. Pediatr Emerg Care. 2015;31:368-372.

According to this retrospective chart review study, clinically significant prescription errors continued to occur at an alarming rate in a pediatric emergency department, despite the introduction of computerized provider order entry. Emergency medicine residents made more prescribing errors than pediatric residents.

Journal Article > Study

Emergency physicians' views of direct notification of laboratory and radiology results to patients using the internet: a multisite survey.

Callen J, Giardina TD, Singh H, et al. J Med Internet Res. 2015;17:e60.

Providing test results directly to patients is one way in which enhanced patient engagement could improve safety, as failure to appropriately follow up on test results is a recognized cause of diagnostic errors. Accomplishing this will require endorsement from physicians, and this survey examines the attitudes of Australian emergency physicians regarding direct provision of test results to patients. The majority of physicians expressed discomfort with patients having direct access to test results, mainly because physicians feared patients would experience undue anxiety or lack the knowledge necessary to interpret the results. More physicians supported providing patients with direct access to normal test results than abnormal test results, mirroring the findings of a prior survey of primary care providers. Physicians were more supportive of direct release of test results if it would decrease their own workload. The results of this survey reveal the need for careful exploration of the best methods to increase patient engagement without disregarding clinicians' concerns. A previous AHRQ WebM&M interview with Dave deBronkart discussed allowing patients to access their medical records.

Journal Article > Study

Color-coded prefilled medication syringes decrease time to delivery and dosing error in simulated emergency department pediatric resuscitations.

Moreira ME, Hernandez C, Stevens AD, et al. Ann Emerg Med. 2015;66:97-106.

Medication errors are common during pediatric resuscitation situations. This study found that use of prefilled and color-coded syringes reduced time needed to prepare and administer medications and significantly decreased dosing errors during simulated resuscitations.

Journal Article > Study

Intercepting wrong-patient orders in a computerized provider order entry system.

Green RA, Hripcsak G, Salmasian H, et al. Ann Emerg Med. 2015;65:679-686.

While computerized physician order entry is expected to significantly reduce adverse drug events, systems must be implemented thoughtfully to avoid facilitating certain types of errors. A forcing function that mandated correct patient identification resulted in a moderate decrease in wrong-patient prescribing errors within a computerized provider order entry system.

Journal Article > Study

Preventing iatrogenic overdose: a review of in–emergency department opioid-related adverse drug events and medication errors.

Beaudoin FL, Merchant RC, Janicki A, McKaig DM, Babu KM. Ann Emerg Med. 2015;65:423-431.

This study was conducted using a trigger tool method in which all cases of naloxone administration in the emergency department were reviewed. Causes of iatrogenic opioid overdose included patient factors such as comorbid conditions, inappropriate prescribing practices such as coadministration of multiple opioid medications, and systems problems including suboptimal handoffs and lack of pharmacy oversight. These results clearly demonstrate the need for multimodal interventions that address the varied factors that contribute to opioid overdose in the emergency department. A recent AHRQ WebM&M commentary describes best practices for opioid prescribing.

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.

Journal Article > Study

Activation of a medical emergency team using an electronic medical recording–based screening system.

Huh JW, Lim CM, Koh Y, et al. Crit Care Med. 2014;42:801-808.

This study describes the experience of a medical emergency team (MET) at a large academic medical center in South Korea. Approximately half of the MET activations were triggered by an electronic medical record–based screening system, resulting in better outcomes compared with patients who had MET activations from other sources.

Book/Report

Healthcare Inspection—Emergency Department Patient Deaths: Memphis VAMC, Memphis, Tennessee.

Washington, DC: Department of Veterans Affairs, Office of Inspector General; October 23, 2013. Report No. 13-00505-348.

This investigation into three patients who died in an emergency department uncovered problems related to medication ordering, alert response, and test result tracking.

Journal Article > Study

Medication safety and knowledge-based functions: a stepwise approach against information overload.

Patapovas A, Dormann H, Sedlmayr B, et al. Br J Clin Pharmacol. 2013;76(supp 1):14-24.

An electronic clinical decision support system for prescribing in the emergency department used tiered alerts with higher and lower urgency information in order to avoid alert fatigue.

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

Effect of barcode-assisted medication administration on emergency department medication errors.

Bonkowski J, Carnes C, Melucci J, et al. Acad Emerg Med. 2013;20:801-806.

Implementation of barcode-assisted medication administration was associated with an 80% reduction in medication administration errors in an urban emergency department.

Journal Article > Commentary

Quality and safety implications of emergency department information systems.

Farley HL, Baumlin KM, Hamedani AG, et al. Ann Emerg Med. 2013;62:399-407.

Many emergency departments (EDs) have recently implemented electronic medical records (EMRs) specifically designed for emergency care. This article evaluates the benefits and potential threats to patient safety of various emergency department information systems (EDISs). Case studies illustrate patient safety pitfalls of inferior EDIS products or of improper implementation. The authors propose seven recommendations for appropriate and safe EDIS deployment, including ED physician engagement, risk transparency from vendors and clients, and a call for legal responsibility from vendors. An AHRQ WebM&M commentary discusses a patient who received an extra dose of vancomycin due to inadequate communication between the EDIS and the hospital EMR.

Journal Article > Commentary

Development of a modified early warning score using the electronic medical record.

Albert BL, Huesman L. Dimens Crit Care Nurs. 2011;30:283-292.

This commentary describes how one hospital developed an early warning score system to improve rapid response team deployment.

Journal Article > Study

Increasing adoption of computerized provider order entry, and persistent regional disparities, in US emergency departments.

Pallin DJ, Sullivan AF, Espinola JA, Landman AB, Camargo CA Jr. Ann Emerg Med. 2011;58:543-550.

Adoption of computerized provider order entry (CPOE) remained low in this survey of emergency departments in four states, with only 30% of respondents having implemented CPOE.

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