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- Title
Effect of Restriction of the Number of Concurrently Open Records in an Electronic Health Record on Wrong-Patient Order Errors: A Randomized Clinical Trial.
- Authors
Adelman, Jason S.; Applebaum, Jo R.; Schechter, Clyde B.; Berger, Matthew A.; Reissman, Stan H.; Thota, Raja; Racine, Andrew D.; Vawdrey, David K.; Green, Robert A.; Salmasian, Hojjat; Schiff, Gordon D.; Wright, Adam; Landman, Adam; Bates, David W.; Koppel, Ross; Galanter, William L.; Lambert, Bruce L.; Paparella, Susan; Southern, William N.
- Abstract
<bold>Importance: </bold>Recommendations in the United States suggest limiting the number of patient records displayed in an electronic health record (EHR) to 1 at a time, although little evidence supports this recommendation.<bold>Objective: </bold>To assess the risk of wrong-patient orders in an EHR configuration limiting clinicians to 1 record vs allowing up to 4 records opened concurrently.<bold>Design, Setting, and Participants: </bold>This randomized clinical trial included 3356 clinicians at a large health system in New York and was conducted from October 2015 to April 2017 in emergency department, inpatient, and outpatient settings.<bold>Interventions: </bold>Clinicians were randomly assigned in a 1:1 ratio to an EHR configuration limiting to 1 patient record open at a time (restricted; n = 1669) or allowing up to 4 records open concurrently (unrestricted; n = 1687).<bold>Main Outcomes and Measures: </bold>The unit of analysis was the order session, a series of orders placed by a clinician for a single patient. The primary outcome was order sessions that included 1 or more wrong-patient orders identified by the Wrong-Patient Retract-and-Reorder measure (an electronic query that identifies orders placed for a patient, retracted, and then reordered shortly thereafter by the same clinician for a different patient).<bold>Results: </bold>Among the 3356 clinicians who were randomized (mean [SD] age, 43.1 [12.5] years; mean [SD] experience at study site, 6.5 [6.0] years; 1894 females [56.4%]), all provided order data and were included in the analysis. The study included 12 140 298 orders, in 4 486 631 order sessions, placed for 543 490 patients. There was no significant difference in wrong-patient order sessions per 100 000 in the restricted vs unrestricted group, respectively, overall (90.7 vs 88.0; odds ratio [OR], 1.03 [95% CI, 0.90-1.20]; P = .60) or in any setting (ED: 157.8 vs 161.3, OR, 1.00 [95% CI, 0.83-1.20], P = .96; inpatient: 185.6 vs 185.1, OR, 0.99 [95% CI, 0.89-1.11]; P = .86; or outpatient: 7.9 vs 8.2, OR, 0.94 [95% CI, 0.70-1.28], P = .71). The effect did not differ among settings (P for interaction = .99). In the unrestricted group overall, 66.2% of the order sessions were completed with 1 record open, including 34.5% of ED, 53.7% of inpatient, and 83.4% of outpatient order sessions.<bold>Conclusions and Relevance: </bold>A strategy that limited clinicians to 1 EHR patient record open compared with a strategy that allowed up to 4 records open concurrently did not reduce the proportion of wrong-patient order errors. However, clinicians in the unrestricted group placed most orders with a single record open, limiting the power of the study to determine whether reducing the number of records open when placing orders reduces the risk of wrong-patient order errors.<bold>Trial Registration: </bold>clinicaltrials.gov Identifier: NCT02876588.
- Subjects
UNITED States; ELECTRONIC health records; CLINICAL trials; HOSPITAL emergency services; ERROR rates; PREVENTION of medical errors; MEDICAL error statistics; ACADEMIC medical centers; COMPARATIVE studies; INFORMATION storage &; retrieval systems; MEDICAL databases; INTEGRATED health care delivery; RESEARCH methodology; MEDICAL cooperation; MEDICAL records; PATIENT safety; RESEARCH; STATISTICAL sampling; EMPLOYEES' workload; EVALUATION research; RANDOMIZED controlled trials
- Publication
JAMA: Journal of the American Medical Association, 2019, Vol 321, Issue 18, p1780
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2019.3698