Search results for "Information Professionals"

This medical education study found that self-reflection only minimally improved diagnostic accuracy among medical residents in a simulation setting. These results suggest that a more robust cognitive debiasing curriculum may be needed to enhance diagnostic decision making.

This systematic review identified 87 randomized controlled trials assessing the effect of information technology on various aspects of medication safety, including studies of computerized provider order entry. Although processes of care consistently improved, few studies demonstrated improvement in clinical outcomes.

The authors present a case study exploring information exchange in a patient care unit and suggest roles that can support patient safety improvement through more effective information flow.

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.

Enterprise risk management focuses on managing risk at the system rather than the unit or incident level. This commentary discusses an enterprise risk management framework to assess and address problems associated with implementing technology. The authors outline potential risks present at the time of purchasing the technology and during pre- and post-implementation phases.

Use of medication administration technologies can reduce transcription errors. This review examined computerized order entry systems, barcode medication administration systems, and other tools that can prevent medication transcription errors.

This survey-based study of primary care providers revealed a lack of standardization for the tracking, receiving, and reporting of laboratory results. Even practices with integrated electronic medical records reported the need for a back-up tracking system to ensure important test results are not lost.

Preventing hospital readmissions has been a major health system priority for several years. Although recent data indicates that readmissions in adult patients are decreasing slightly, the approaches individual hospitals or health systems should use to prevent readmissions remain unclear. This randomized controlled trial evaluated the effect of a postdischarge virtual ward where patients received postdischarge care from a multidisciplinary team that met daily to review the patient's progress, conduct home visits, arrange home services, and coordinate care with the patient's primary physicians. Patients were admitted to the virtual ward for a mean of 35 days after discharge and received 3 home visits on average during that time. Despite the intensity of the intervention, there was no effect on 30-day readmissions or any other clinical outcome compared to usual postdischarge care. Another recent randomized trial found that a similarly intensive intervention did not reduce readmissions in a vulnerable elderly patient population. The authors of this study note that difficulty in communicating with primary care physicians, exacerbated by the lack of an integrated electronic medical record, may have contributed to the failure of the virtual ward at preventing readmissions.

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.

Medication error rates are extremely high among patients receiving outpatient chemotherapy. This systematic review found a paucity of studies on the effectiveness of computerized provider order entry (CPOE) in improving the safety of chemotherapy, but concluded that the limited evidence supports wider use of CPOE in this setting.

Highlighting how heuristics can both increase and reduce risk of diagnostic error, this commentary applies a set of recommended criteria to examine its usefulness in guiding research and augmenting understanding about factors that affect clinical reasoning and support accurate decision making.

Home care is one of the fastest growing sectors of the health care field, but recent research has raised safety concerns among patients receiving home services. A prospective cohort study revealed that 10% of home care patients experienced an adverse event, an incidence comparable to that found in hospitalized patients. This study used a Delphi approach to determine the types of adverse events in home care that should be considered serious (in terms of the level of patient harm) and preventable. Four types of serious preventable events were identified: inappropriate client service plans, medication errors requiring emergency treatment, catheter-associated infections, and incidents related to care that did not fall within practice standards. The authors advocate for using this classification scheme as the basis for a home care adverse event reporting system, analogous to state reporting systems for serious errors occurring in hospitalized patients.

Using administrative data as a means of detecting safety problems has inherent appeal, as these data are already routinely collected. However, many prior studies have shown that these data have limited ability to identify adverse events, in large part because adverse events are not specifically delineated in these databases, which are assembled primarily for billing purposes. This systematic review found that this problem is likely to persist with the new ICD-10 coding system. The review searched for studies that attempted to identify adverse drug events by searching administrative data and found that more than 800 different ICD-10 codes could be used to detect medication errors, with the combination of codes varying widely across studies. These findings support the concept that complementary data sources must be used to comprehensively assess patient safety within an organization.

A cornerstone of the medication reconciliation process is assembling the best possible medication history—the gold standard list of a patient's prescription and over-the-counter medications. This cohort study, conducted in an emergency department (ED) in Quebec, compared the medication history obtained by ED staff with the gold standard list of dispensed medications from their community pharmacy. The overall concordance between the two medication lists was poor, and most concerningly, more than 75% of patients had at least one medication noted in their pharmacy list that was not known to the ED. These errors of omission occurred most frequently for medications that were prescribed episodically (i.e., antibiotics) or on an as-needed basis (i.e., pain medications). The development of health information exchanges that give hospital providers direct access to pharmacy records could prevent such errors. A serious medication error due to a problem with medication reconciliation is described an AHRQ WebM&M commentary.

This review explores errors associated with health information technology, including methods to identify, understand, monitor, and prevent them.

This narrative review examines literature and organizational resources related to health information technology (IT) use in three countries, including barriers to implementation, technology-induced errors, and initiatives to enhance health IT safety.

The difficulty of accurately identifying and classifying inpatient adverse drug events (ADEs) was first recognized nearly a half century ago. This systematic review sought to evaluate the accuracy of trigger tools, an increasingly common technique used to screen electronic databases for evidence of ADEs. Triggers have been used in this fashion to identify ADEs from inpatient laboratory systems and outpatient electronic health records. This review found that the overall performance of electronic ADE detection systems was poor, and the quality of the studies was limited by variations in ADE definitions and failure to use gold standard methods for validating ADEs. Although they are a promising method for identifying ADEs promptly, the review concludes that electronic triggers still have serious limitations.

Dictated radiology reports were far more likely to contain a major error if transcribed by automated methods, compared to traditional transcription by human transcriptionists.

This study underscores the importance of heuristic evaluations in the design, selection, and implementation of computerized provider order entry systems.

This systematic review of methods to reduce medication administration errors, including technological approaches such as bar coding and smart intravenous pumps, found little generalizable evidence to support use of specific interventions.