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Search results for "Information Professionals"

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Journal Article > Review

Identifying patients with sepsis on the hospital wards.

Bhattacharjee P, Edelson DP, Churpek MM. Chest. 2017;151:898-907.

Undiagnosed sepsis can lead to serious patient harm. This review describes proactive methods of monitoring patients to augment detection and early treatment of sepsis. The authors discuss how this process has evolved over time and suggest that automated tools can aid in identifying and managing sepsis.

Perspectives on Safety > Interview

In Conversation With… Robert M. Wachter, MD

New Insights on Safety and Health IT, July/August 2015

Dr. Wachter is Professor and the Interim Chairman of the Department of Medicine at UCSF. We talked with him about his new book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age.

Journal Article > Study

Impact of introducing an electronic physiological surveillance system on hospital mortality.

  • Classic

Schmidt PE, Meredith P, Prytherch DR, et al. BMJ Qual Saf. 2015;24:10-20.

Many patients show physiological signs of worsening for several hours prior to requiring more aggressive interventions and transfer to a higher level of care. Rapid response teams have been widely deployed to address this problem, but this approach is fundamentally reactive rather than proactive and has had mixed results so far. This time series study utilized an electronic physiological surveillance system—a real-time decision support system based on patients' vital signs—embedded within the electronic medical record to provide guidance for clinicians in determining patients at risk for deterioration and optimizing treatment intensity. Implementation of the electronic physiological surveillance system was associated with a statistically significant reduction in mortality for a broad range of diagnoses at both hospitals. The results of this study illustrate the potential of novel information technology approaches for prospectively identifying patients at risk for clinical harm.

Journal Article > Study

Validating administrative data for the detection of adverse events in older hospitalized patients.

Ackroyd-Stolarz S, Bowles SK, Giffin L. Drug Healthc Patient Saf. 2014;6:101-108.

This validation study found that diagnostic codes in administrative data for hospital-related complications such as pressure ulcers, falls, and adverse drug events accurately reflect the presence of these events in the medical record. This suggests that administrative data can be used to assess the incidence of these complications.

Journal Article > Review

Automated and electronically assisted hand hygiene monitoring systems: a systematic review.

Ward MA, Schweizer ML, Polgreen PM, Gupta K, Reisinger HS, Perencevich EN. Am J Infect Control. 2014;42:472-478.

This systematic review evaluated new technologies for assisting hand hygiene monitoring, including automated counting systems, video monitoring, and fully automated monitoring systems. Currently, there is very limited data about how accurate, effective, and valuable these strategies are in enhancing hand hygiene compliance.

Journal Article > Study

Identifying critically ill patients at risk for inappropriate antibiotic therapy: a pilot study of a point-of-care decision support alert.

Micek ST, Heard KM, Gowan M, Kollef MH. Crit Care Med. 2014;42:1832-1838.

A decision support alert within an electronic medical record was able to identify patients with health care–associated infections (HAIs) who were being administered inappropriate antibiotic therapy. These findings suggest that clinical decision support systems can improve safety of antibiotic prescribing for intensive care unit patients with suspected HAIs.

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

A framework for evaluating the appropriateness of clinical decision support alerts and responses.

McCoy AB, Waitman LR, Lewis JB, et al. J Am Med Inform Assoc. 2012;19:346-352.

Increasing adoption of clinical decision support systems (CDSS) is driven by evidence that a well-designed system may impact provider behavior, medication safety, and patient outcomes. This study developed a framework to assess the clinical appropriateness of alerts, and applied the framework to alerts designed for patients with acute kidney injury. The authors identified rates of false positive alerts, alert overrides, provider non-adherence, and provider response appropriateness. Using their proposed framework, they advocate for systematic approaches to implementing and evaluating CDSS to optimize alert adherence and minimize alert overrides. A past AHRQ WebM&M commentary discussed integrating CDSS to improve medication safety.

Journal Article > Study

Comparison of computerized surveillance and manual chart review for adverse events.

Tinoco A, Evans RS, Staes CJ, Lloyd JF, Rothschild JM, Haug PJ. J Am Med Inform Assoc. 2011;18:491-497.

This study found that computerized surveillance systems detected more hospital-acquired infections than manual chart review, but both methods detected similar rates of adverse drug events. The authors discuss the tradeoffs of each surveillance method and highlight how each system used information from different sources.

Journal Article > Study

Effect of a pharmacist-led multicomponent intervention focusing on the medication monitoring phase to prevent potential adverse drug events in nursing homes.

Lapane KL, Hughes CM, Daiello LA, Cameron KA, Feinberg J. J Am Geriatr Soc. 2011;59:1238-1245.

An information technology–based intervention, which identified nursing home patients at high risk for adverse drug events and recommended customized management strategies, successfully reduced the risk of delirium.

Special or Theme Issue

Biomedical Complexity and Error.

Patel VL, Kahol K, Buchman T, eds. J Biomed Inform. 2011;44:385-506. 

This special issue explores complexity in error management, clinical workflow, and decision making.

Special or Theme Issue

Quality of Anesthesia Care. 

Neuman MD, Martinez EA, eds. Anesthesiol Clin. 2011;29:1-178.

This special issue includes articles discussing safety in anesthesiology practice as well as quality improvement innovations.

Journal Article > Review

The safety implications of missed test results for hospitalised patients: a systematic review.

  • Classic

Callen J, Georgiou A, Li J, Westbrook JI. BMJ Qual Saf 2011;20:194-199.

Adverse events after hospital discharge are a growing driver for safety interventions, including a focus on readmissions, adverse drug events, and hospital-acquired infections. Another safety area ripe for intervention is managing test results after hospital discharge. This systematic review analyzed 12 studies and found wide variation in rates of test follow-up and related management systems. Critical test results and results for patients moving across health care settings were highlighted as particularly concerning areas that could be addressed with better clinical information systems. A past AHRQ WebM&M commentary discussed a case where a patient was incorrectly treated based on failure to follow up a urine culture after hospital discharge.

Journal Article > Study

From research to practice: factors affecting implementation of prospective targeted injury-detection systems.

Sorensen AV, Harrison MI, Kane HL, Roussel AE, Halpern MT, Bernard SL. BMJ Qual Saf. 2011;20:527-533.

This study explores the barriers five hospitals faced in implementing new systems for prospective detection of adverse drug events and pressure ulcers, and recommends steps organizations can take to ensure smoother implementation.

Newspaper/Magazine Article

As industry automates, adverse events continue to haunt caregivers.

Wetzel TG. Health Data Manage. 2011 Feb;19:86, 88, 90 passim.

This article discusses how several health care organizations used health information technology to improve organizational transparency.

Journal Article > Study

Fall prevention in acute care hospitals: a randomized trial.

  • Classic

Dykes PC, Carroll DL, Hurley A, et al. JAMA. 2010;304:1912-1918.

Patient falls are among the preventable complications of hospital care for which hospitals no longer receive additional reimbursement from the Centers for Medicare and Medicaid Services. Experts in the field have questioned the wisdom of this policy; even though falls are common, little evidence has been available to guide fall prevention strategies. This randomized controlled trial offers an advance in fall prevention, as it demonstrated a significant reduction in falls by using a customized fall prevention strategy. The study also represents a novel application of information technology to improve patient safety, as the patient-specific fall prevention toolkit was developed with a novel software application drawing from the electronic medical record.

Journal Article > Study

Use of an electronic information system to identify adverse events resulting in an emergency department visit.

Ackroyd-Stolarz S, Mackinnon NJ, Zed PJ, Murphy N. Qual Saf Health Care. 2010;19:e53.

This study used routinely collected electronic data to uncover information about adverse events not easily captured through other mechanisms.

Journal Article > Review

Automated detection of harm in healthcare with information technology: a systematic review.

Govindan M, Van Citters AD, Nelson EC, Kelly-Cummings J, Suresh G. Qual Saf Health Care. 2010;19:e11.

This systematic review identified a number of methods used for automated detection of safety events, including adverse drug events and nosocomial infections. However, the accuracy of error detection varied widely between different systems.

Journal Article > Study

Development of trigger tools for surveillance of adverse events in ambulatory surgery.

Kaafarani HM, Rosen AK, Nebeker JR, et al. Qual Saf Health Care. 2010;19:425-429.

Ambulatory surgery remains a relatively understudied area of patient safety. This article proposes a novel trigger tool for detecting postoperative adverse events after ambulatory surgical procedures.

Journal Article > Study

Connected care: reducing errors through automated vital signs data upload.

Smith LB, Banner L, Lozano D, Olney CM, Friedman B. Comput Inform Nurs. 2009;27:318-323.

A fully automated system for documenting physiologic data, which included wireless upload of clinical information directly into the electronic medical record, nearly eliminated errors in documentation of vital signs.

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