Limiting the number of open charts does not impact wrong patient order entry in the emergency department

Canfield, Christina; Udeh, Chiedozie; Blonsky, Heather; Hamilton, Aaron; Fertel, Baruch S.

doi:10.1002/emp2.12129

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…The study of Canfield et al (2020) reported error event rates per thousand order sessions for restricted and unrestricted conditions of 2.2/1000 and 2.4/1000, respectively. They reported the total number of order session instances across the entire study ( n = 5,988,914), but did not give the subtotals for the two conditions and hence could not be included in computing a pooled effect size for all studies.…”

Section: Methodsmentioning

confidence: 99%

Effects on wrong-patient errors by limiting access to concurrently open ERH charts: A preliminary systematic mapping and synthesis review

Myronuk

2023

Preprint

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Background: Several recent outcome studies have been published looking at the effects of restricting electronic health record (EHR) user interfaces to limit the number of concurrently accessible patient records. Strong recommendations have been in place for several years to have user interfaces constrained to only display one patient chart at a time in order to reduce the risk of data (documentation, orders) being entered on the wrong patient (Joint Commission, 2015; ONC, 2016). This recommendation was made based on expert opinion rather than objective information, raising the question whether the accumulating evidence supports continued implementation of such chart access restrictions. Objectives: This work reports a systematic mapping and synthesis review addressing research questions, "What is the evidence that restricting the number of concurrently open records reduces errors?" (RQ1), "How effective is restriction of concurrently open charts at reducing wrong-patient errors?" (RQ2), and "What additional inquiry is needed to make evidence-based policy decisions about restricting concurrent chart access?" (RQ3). Methods: A systematic search of CINAHL, PubMed, and Web of Science databases was performed with full search string specification to retrieve a result set that is the conjunction of result sets for concepts of EHR, concurrently open charts, and medical error. Of 407 studies identified and screened, five were eligible for inclusion in the qualitative synthesis review, and three were amenable to data extraction and pooled effect size calculation. Results: None of the studies included for review found evidence of statistically significant change in wrong-patient error rates associated with implementing restriction in the number of patient records allowed to be open concurrently in the EHR. The combined OR for the pooled studies was 1.02 (95% CI 0.90 - 1.15) with low estimates for inter-study heterogeneity and no indication of publication bias. Conclusion: There is no evidence that restricting the number of concurrently open records reduces errors (RQ1). It is not possible to definitively answer RQ2, but the magnitude of any yet to be detected beneficial effect that might be lost with lifting of chart access restriction can be no greater than an absolute risk increase of 33 errors per 100,000 ordering sessions. While it has been claimed that restricting the number of concurrently open EHR records is necessary for patient safety, the present review demonstrates that it is insufficient to attain a measurable improvement in error rates. Additional investigation of the usability and human factors aspects of EHR configuration decisions as well as knowledge of the impacts on clinical workflows will be necessary to provide policymakers, operational leaders, and practitioners with insight into the nature of the threats and opportunities with respect to safety, as well as the strengths and weaknesses of potential interventions.

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Section: Methodsmentioning

confidence: 99%

Effects on wrong-patient errors by limiting access to concurrently open ERH charts: A preliminary systematic mapping and synthesis review

Myronuk

2023

Preprint

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“…While this solution showed early promise, recent studies have found that limiting the number of open charts made no significant difference in the number of wrong-patient orders. [26][27][28] Prior studies have also identified HIT enhancements to improve identification of wrong-patient errors in radiology. One study implemented radiopaque patient identification stickers as an additional check to ensure the patients' conditions correlated with their imaging, and a second study involved capturing photographs of patients' faces simultaneously with portable chest radiographs.…”

Section: Wrong-patient Errors During Orderingmentioning

confidence: 99%

Health Information Technology–Related Wrong-Patient Errors: Context is Critical

et al. 2020

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Health information technology (HIT) provides many benefits, but also facilitates certain types of errors, such as wrong-patient errors in which one patient is mistaken for another. These errors can have serious patient safety consequences and there has been significant effort to mitigate the risk of these errors through national patient safety goals, in-depth research, and the development of safety toolkits. Nonetheless, these errors persist. We analyzed 1,189 patient safety event reports using a safety science and resilience engineering approach, which focuses on identifying processes to discover errors before they reach the patient so these processes can be expanded. We analyzed the general care processes in which wrong-patient errors occurred, the clinical process step during which the error occurred and was discovered, and whether the error reached the patient. For those errors that reached the patient, we analyzed the impact on the patient, and for those that did not reach the patient, we analyzed how the error was caught. Our results demonstrate that errors occurred across multiple general care process areas, with 24.4% of wrong-patient error events reaching the patient. Analysis of clinical process steps indicated that most errors occurred during ordering/prescribing (n=498; 41.9%) and most errors were discovered during review of information (n=286; 24.1%). Patients were primarily impacted by inappropriate medication administration (n=110; 37.9%) and the wrong test or procedure being performed (n=65; 22.4%). When errors were caught before reaching the patient, this was primarily because of nurses, technicians, or other healthcare staff (n=303; 60.5%). The differences between the general care processes can inform wrong-patient error risk mitigation strategies. Based on these analyses and the broader literature, this study offers recommendations for addressing wrong-patient errors using safety science and resilience engineering, and it provides a unique lens for evaluating HIT wrong-patient errors.

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Association between limiting the number of open records in a tele-critical care setting and retract–reorder errors

Udeh

Canfield

Briskin

et al. 2021

Journal of the American Medical Informatics Association

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Background Wrong patient selection errors may be tracked by retract–reorder (RAR) events. The aim of this quality improvement study was to assess the impact of reducing the number of concurrently open electronic health records from 4 to 2 on RAR errors generated by a tele-critical care service. Methods The study encompassed 32 months before and 21 months after restriction. Chi-Square test of proportions and T statistical process control chart for rare events were used. Results There were 156 318 orders with 57 RAR errors (36.5/100 000 orders) before restriction, and 122 587 orders with 34 errors (27.7/100 000 orders) after. Rates were not statistically different (P = .20), but analysis was underpowered. When plotted on a T control chart, random variation was detected between RAR errors. Conclusion We found no significant difference in RAR errors in the tele-critical care setting after open record limitation. Other strategies should be studied to reduce wrong patient selection errors.

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Limiting the number of open charts does not impact wrong patient order entry in the emergency department

Cited by 3 publications

References 18 publications

Effects on wrong-patient errors by limiting access to concurrently open ERH charts: A preliminary systematic mapping and synthesis review

Effects on wrong-patient errors by limiting access to concurrently open ERH charts: A preliminary systematic mapping and synthesis review

Health Information Technology–Related Wrong-Patient Errors: Context is Critical

Association between limiting the number of open records in a tele-critical care setting and retract–reorder errors

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