Search results for "Information Professionals"

Simulation has been explored as a way to improve teamwork, crisis management, and technical skills in surgery. This review analyzes the evidence base on surgical simulation and identifies areas of progress, including curricula development, training techniques, and feedback methods. However, there is still a lack of data confirming the impact of simulation interventions on patient outcomes.

Drawing from Agency for Healthcare Research and Quality's (AHRQ) 2001 comprehensive patient safety literature analysis, the authors determined the most cited and influential patient safety papers.

The recent National Academy of Medicine report on improving diagnosis cited the need for enhanced clinical decision support. This pre–post study used a simulation approach (standardized patients) to compare visits with and without use of a diagnostic clinical decision aid embedded in the electronic health record. The patients' visit satisfaction ratings did not differ in the visits with and without the decision support, although more patients in the decision support group noted that physicians focused more on the computer than the patient. The physicians reported high overall satisfaction with the decision tool, but they noted that it required inputting more clinical documentation during the visit, resulting in more time directed at the electronic health record. The authors conclude that the clinical decision support tool interface should be improved in order to facilitate adoption of real-time diagnostic support.

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.

Handoffs and weekend care are two error-prone elements of health care. This commentary describes a project that focused on shifting from a paper-based to an electronic handoff process to enhance handover reliability over the weekend. The authors explain how using plan-do-study-act cycles helped augment implementation of the new handoff process. A recent PSNet interview discussed the weekend effect in health care.

Smart pumps play an important role in preventing medication errors, but they can also introduce patient safety hazards. This commentary describes software that can be loaded on smart pumps to help manage dosing errors and how to successfully implement it.

Although computerized provider order entry systems are widely implemented, a prior review suggests that their ability to reduce adverse drug events remains uncertain. Less is known about their impact on safety culture. Researchers administered a modified Safety Attitudes Questionnaire survey 6 weeks after the implementation of an electronic prescribing system across surgical services at one hospital and found a decline in safety culture.

Although computerized provider order entry is known to reduce medication errors, previous research has demonstrated that electronic prescribing can introduce new medication safety risks. This observational qualitative study of electronic prescribing at six British hospitals included direct observation, interviews, and analysis of implementation documents. Investigators determined multiple unintended consequences of electronic prescribing, at every stage of use, and identified design flaws in electronic prescribing platforms. Suboptimal implementation of electronic prescribing, with partial functionality and insufficient training, increased risk of errors. Once electronic prescribing was in place, prescribers started using workarounds and relied too much on the prescribing platform. The authors call for design and organizational strategies to mitigate these safety concerns. A past WebM&M commentary described a medication error related to electronic prescribing.

Improving diagnosis in outpatient care is a patient safety priority. This simulation study evaluated the process of diagnosis in the primary care setting. Investigators contrasted physicians' diagnostic accuracy conducting a primary care visit in their usual manner versus using a clinical decision support tool. Each visit employed a standardized patient (an actor reporting symptoms consistent with a given diagnosis) and the visits with and without decision support were matched for complexity. The tool improved diagnostic accuracy significantly: 68% of visits using decision support reached the correct diagnosis versus 59% of usual care visits. The duration of visits and number of subspecialty consultations did not change with or without decision support. Physician participants rated the usability of the decision support tool favorably overall. These data suggest that decision support can be feasibly integrated into primary care to improve diagnostic accuracy.

The Institute for Healthcare Improvement's Global Trigger Tool is widely used to identify adverse events. This systematic review found variation in how the tool is implemented, with differing rates of adverse events detected. The authors suggest modifying the trigger tool to capture errors of omission and to assess the preventability of events identified.

Although electronic health records (EHRs) with computerized provider order entry are known to improve medication safety, experts have raised concerns that EHRs adversely affect interprofessional communication by reducing personal interactions among providers. This study examined unidirectional computerized messages from pharmacists and physicians within the EHR. Investigators found that less than half of messages from pharmacists were acknowledged by the prescribing physicians. Among the messages in which pharmacists requested a specific action, physicians completed the action about one-third of the time. Messages were more likely to be acknowledged and acted upon when pharmacists and physicians had an existing working relationship. The authors suggest that EHRs should be better designed to foster interprofessional collaboration. A PSNet perspective highlighted the role of pharmacists in interprofessional care and safety.

Insufficient training on electronic health record systems can hinder user satisfaction. This literature review assessed the evidence on training methods, such as simulation scenarios and classroom-based sessions, for electronic prescribing systems. The authors suggest that future research should examine how to educate users about challenges associated with electronic systems.

The weekend effect refers to the fact that mortality for several common conditions is higher in patients admitted on weekends compared to weekdays. While the mechanism for this effect is unclear, it likely varies for different disease processes. For example, prior studies have postulated that a weekend effect exists for patients with acute stroke. However, this study analyzed a large British database and found that many patients with a history of stroke who were later hospitalized for other reasons had their admission diagnosis inaccurately documented as acute stroke. This inaccuracy occurred more frequently in patients admitted on weekdays. Because the weekday admissions included many patients who were hospitalized for less morbid conditions, mortality appeared lower for patients admitted on weekdays than on weekends. When data was reanalyzed to include only those patients with a true acute stroke, no weekend effect was found. This study demonstrates the limitations of administrative data in analyzing patient safety issues.

Computerized provider order entry systems are now widely deployed in hospitals, but their effectiveness at preventing adverse drug events has thus far been less impressive than hoped. Some of this lack of effect may be due to users engaging in workarounds that bypass safety features in order to preserve efficiency. This study used direct observation and interviews to characterize the types of workarounds used by clinical staff at five hospitals in the United Kingdom. Although some workarounds were endorsed by management (such as those to be used if the system was down), most were informal and related to difficulty using the software or to preserve professional roles (for example, senior doctors would delegate prescribing to trainees). Use of workarounds was associated with new potential safety risks, but the authors note that workarounds often represent a reasonable adaptation on the part of frontline staff—especially if the technology itself is not easy to use. They therefore advocate for more formal characterization of workarounds as a part of human factors engineering approaches to improving safety.

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.

Despite increasing focus on diagnostic error, it remains a controversial patient safety issue. The Institute of Medicine recently suggested that further research is needed regarding electronic tools to improve diagnosis. Differential diagnosis generators provide a list of possible diagnoses for a problem. The investigators conducted a systematic review and found that differential diagnosis generators have been shown to improve diagnostic accuracy when a clinician has an opportunity to re-review the case using the software in pre-post studies. The degree of improvement varied between studies. The effect on actual clinician behaviors—such as test ordering, clinical outcomes, and cost—is unclear. Clinicians need prospective studies in order to determine whether such tools enhance diagnosis in actual practice. A recent PSNet perspective discussed future research avenues to ensure progress in diagnostic safety.

This retrospective study of abnormal laboratory test orders and results in primary care uncovered multiple vulnerabilities, similar to prior studies. The authors describe a conceptual model to comprehensively address the safety of laboratory testing and results management in primary care, a useful step for future interventions.

Prescribing errors are a serious source of patient harm in primary care. This cross-sectional study in the United Kingdom found wide variation in the prevalence of potentially hazardous prescribing ranging from nearly zero to 10%, and for inadequate medication monitoring ranging from 10% to 42% between practices.

Interruptions pose a significant safety hazard for health care providers performing complex tasks and increase the risk of errors. This commentary describes a simulated training initiative to help prepare nursing students for experiencing and responding to interruptions during medication administration.

This cross-sectional study of patient records found that linked primary and secondary care data provides a more robust surveillance of medication safety. Older patients and those prescribed multiple medications were at highest risk for prescribing hazards.