Background Despite over a decade of efforts to reduce the adverse event rate in healthcare, the rate has remained relatively unchanged. Root cause analysis (RCA) is a process used by hospitals in an attempt to reduce adverse event rates; however, the outputs of this process have not been well studied in healthcare. This study aimed to examine the types of solutions proposed in RCAs over an 8-year period at a major academic medical institution. Methods All state-reportable adverse events were gathered, and those for which an RCA was performed were analysed. A consensus rating process was used to determine a severity rating for each case. A qualitative approach was used to categorise the types of solutions proposed by the RCA team in each case and descriptive statistics were calculated. Results 302 RCAs were reviewed. The most common event types involved a procedure complication, followed by cardiopulmonary arrest, neurological deficit and retained foreign body. In 106 RCAs, solutions were proposed. A large proportion (38.7%) of RCAs with solutions proposed involved a patient death. Of the 731 proposed solutions, the most common solution types were training (20%), process change (19.6%) and policy reinforcement (15.2%). We found that multiple event types were repeated in the study period, despite repeated RCAs. Conclusions This study found that the most commonly proposed solutions were weaker actions, which were less likely to decrease event recurrence. These findings support recent attempts to improve the RCA process and to develop guidance for the creation of effective and sustainable solutions to be used by RCA teams.

SummaryObjective: Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Materials and Methods: Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. Results: We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Discussion: Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Conclusion: Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation. Citation: Ratwani R et al.: Review to identify usability and safety challenges and practices during EHR implementation.

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In a complex, dynamic system such as healthcare delivery, there is often a “gap” between work as imagined (how clinical workflow ideally occurs) and work as done (how clinical workflow occurs in real-time). Therefore, it is critical when implementing new health information technology to work within the constraints of hospital-specific workflow to understand the reality of work, rather than relying solely on how it is reported. The present research seeks to fully understand the current state of workflow as it relates to cardiovascular risk calculation, with the ultimate goal of implementing an atherosclerotic cardiovascular disease risk calculator within the clinicians’ electronic health record. By conducting both interviews and observations, researchers were able to compare work as imagined to work as done in order to implement the risk calculator to meet clinician needs.

Developing novel interfaces for high-risk situations, such as the Emergency Department, requires a sufficient quantity of detailed patient data to support usability and evaluation activities, yet patient privacy restrictions often prevent the use of actual patient data for these activities. We developed a synthetic dataset to provide a suitable alternative to the use of actual patient data that can be integrated into a variety of research activities. The Emergency Department Information Systems (EDIS) Dataset was developed through close collaboration of experts in Emergency Medicine, Human Factors, and Systems Engineering and provides an ecologically valid set of data for 54 patients, treated in an Emergency Department operating at steady-state, with realistic patient loads and flow. The dataset includes both static and dynamic data for each patient case over a 500-minute time period. A sample application of the dataset is provided to demonstrate how the dataset was used to support the design and evaluation of novel EDIS interface displays and its potential adaptation for future HIT research. This dataset provides a readily adaptable alternative to researchers in need of synthetic patient data to support HIT research and development activities. The EDIS dataset and supporting material are freely available through the University at Buffalo Institutional Repository and can be directly accessed with the URL: hdl.handle.net/10477/75188 .