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Intercepting Wrong-Patient Orders in a Computerized Provider Order Entry System - 24/05/15

Doi : 10.1016/j.annemergmed.2014.11.017 
Robert A. Green, MD, MA a, e, , George Hripcsak, MD, MS b, d, Hojjat Salmasian, MD, MPH b, Eliot J. Lazar, MD, MBA e, Susan B. Bostwick, MD, MBA f, Suzanne R. Bakken, RN, PhD b, c, David K. Vawdrey, PhD b, d
a Department of Emergency Medicine, Columbia University Medical Center and NewYork–Presbyterian Hospital, New York, NY 
b Department of Biomedical Informatics, Columbia University, New York, NY 
c School of Nursing, Columbia University, New York, NY 
d Medical Informatics Services, NewYork-Presbyterian Hospital, New York, NY 
e Division of Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, NY 
f Department of Pediatrics, Weill Cornell Medical College, New York, NY 

Corresponding Author.

Abstract

Study objective

We evaluate the short- and long-term effect of a computerized provider order entry–based patient verification intervention to reduce wrong-patient orders in 5 emergency departments.

Methods

A patient verification dialog appeared at the beginning of each ordering session, requiring providers to confirm the patient's identity after a mandatory 2.5-second delay. Using the retract-and-reorder technique, we estimated the rate of wrong-patient orders before and after the implementation of the intervention to intercept these errors. We conducted a short- and long-term quasi-experimental study with both historical and parallel controls. We also measured the amount of time providers spent addressing the verification system, and reasons for discontinuing ordering sessions as a result of the intervention.

Results

Wrong-patient orders were reduced by 30% immediately after implementation of the intervention. This reduction persisted when inpatients were used as a parallel control. After 2 years, the rate of wrong-patient orders remained 24.8% less than before intervention. The mean viewing time of the patient verification dialog was 4.2 seconds (SD=4.0 seconds) and was longer when providers indicated they placed the order for the wrong patient (4.9 versus 4.1 seconds). Although the display of each dialog took only seconds, the large number of display episodes triggered meant that the physician time to prevent each retract-and-reorder event was 1.5 hours.

Conclusion

A computerized provider order entry–based patient verification system led to a moderate reduction in wrong-patient orders that was sustained over time. Interception of wrong-patient orders at data entry is an important step in reducing these errors.

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 Please see page 680 for the Editor’s Capsule Summary of this article.
 Supervising editor: Daniel A. Handel, MD, MPH
 Author contributions: RAG, GH, EJL, and DKV conceived and developed the intervention. RAG and DKV collaborated on data acquisition. HS performed data analysis, conducted the literature review, and drafted the manuscript. SSB and SRB provided overall mentorship, particularly related to planning and evaluation. All authors participated in writing and editing. RAG takes responsibility for the paper as a whole.
 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. This study was supported in part by National Library of Medicine grants 5 T15 LM007079 and LM006910.
 A 59DFCXV survey is available with each research article published on the Web at www.annemergmed.com.
 A podcast for this article is available at www.annemergmed.com.


© 2014  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 65 - N° 6

P. 679 - juin 2015 Retour au numéro
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