The computer-based monitor identified fewer ADEs than did chart review but many more ADEs than did stimulated voluntary report. The overlap among the ADEs identified using different methods was small, suggesting that the incidence of ADEs may be higher than previously reported and that different detection methods capture different events. The computer-based monitoring system represents an efficient approach for measuring ADE frequency and gauging the effectiveness of ADE prevention programs.

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An automatic alerting system reduced the time until an appropriate treatment was ordered for patients who had critical laboratory results. Information technologies that facilitate the transmission of important patient data can potentially improve the quality of care.

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Although CLRs meeting the hospital's criteria were reported promptly by the laboratory, treatment delays were still common. Results that did not meet the hospital's critical criteria but still represented serious clinical situations were more often associated with treatment delays. Difficulty communicating critical results directly to the responsible caregiver is the likely cause of some delays in treatment. New communications methods, including computer-based technologies, should be explored and tested for their potential to reduce treatment delays and improve clinical care.

BACKGROUND: Prior research indicates that female physicians spend more time working in the electronic health record (EHR) than do male physicians. OBJECTIVE: To examine gender differences in EHR usage among primary care physicians and identify potential causes for those differences. DESIGN: Retrospective study of EHR usage by primary care physicians (PCPs) in an academic hospital system. PARTICIPANTS: One hundred twenty-five primary care physicians INTERVENTIONS: N/A MAIN MEASURES: EHR usage including time spent working and volume of staff messages and patient messages. KEY RESULTS: After adjusting for panel size and appointment volume, female PCPs spend 20% more time (1.9 h/month) in the EHR inbasket and 22% more time (3.7 h/month) on notes than do their male colleagues (p values 0.02 and 0.04, respectively). Female PCPs receive 24% more staff messages (9.6 messages/month), and 26% more patient messages (51.5 messages/month) (p values 0.03 and 0.004, respectively). The differences in EHR time are not explained by the percentage of female patients in a PCP's panel. CONCLUSIONS: Female physicians spend more time working in their EHR inbaskets because both staff and patients make more requests of female PCPs. These differential EHR burdens may contribute to higher burnout rates in female PCPs.

We developed an adverse drug event (ADE) monitor based on published rules, and used it to detect admissions to the hospital due to ADEs. Over the study period, the ADE monitor identified 76 admissions to the hospital due to ADEs. Ofthese, 21 were determined to be preventable. The hospitalwide rate of admissiotns due to ADEs was 1.4/1)00 admissions and the preventable ADE admission rate was 0. 4/1() admissions. 7The 76 eventts were associated with $1.2 million in costs. The computer monitor required 1I person hours a week to execute.

Within the context of longitudinal medical care for adults, health care providers have a unique opportunity to inquire and respond to the traumatic life experiences affecting the health of their patients, as well as a responsibility to minimize retraumatizing these patients during medical encounters. While there is literature on screening women for intimate partner violence, and there is emerging data on pediatric screening for adverse life experiences, there is sparse literature on inquiry of broader trauma histories in adult medical settings. This lack of research on trauma inquiry results in an absence of guidelines for best practices, in turn making it challenging for policy makers, health care providers, and researchers to mitigate the adverse health outcomes caused by traumatic experiences and to provide equitable care to populations that experience a disproportionate burden of trauma. This state of the science summarizes current inquiry practices for patients who have experienced trauma, violence, and abuse. It places trauma inquiry within an anchoring framework of trauma-informed care principles, and emphasizes a focus on resilience. It then proposes best practices for trauma inquiry, which include tiered screening starting with broad trauma inquiry, proceeding to risk and safety assessment as indicated, and ending with connection to interventions.