Patient safety experts worry that CPOE systems that allow multiple patient records open at once increases the risk of wrong patient errors. A recent national survey of Chief Medical Information Officers demonstrated the lack of consensus on the safest number of patient records to allow opened at once, with marked heterogeneity in the number of records currently allowed open by IT leadership. Our application will be the first study to provide IT leaders data on the risk of wrong patient errors when varying number of records are opened at once, which will help them make a more informed decision on the best configuration for their CPOE systems. We propose a large observational study to examine the relationship between the number of records open and the risk of wrong-patient error (Aim 1). It is possible, however, that clinical environments where providers are more likely to open more than one record at a time may also be the clinical settings in which wrong patient errors are more likely to occur, and the type of clinical setting or other factors may confound the observational study. To address the threat of confounding, we also propose a two-armed crossover pilot study in which the CPOE system will be configured to limit the number of records opened to one patient at a time for roughly half the inpatient beds (restricted environment), while the other half of the inpatient beds will be allowed to open a maximum of four records at once (unrestricted environment); midway through the pilot study these configurations will be reversed (Aim 2). A comparison of the wrong-patient error rates in the restricted and unrestricted cohorts will help further quantify the risk of having multiple records open at once. This study is made possible by an innovative tool for identifying wrong patient electronic orders that was developed and validated at Montefiore Medical Center. This tool, which identified an average of 14 wrong patient errors a day at Montefiore, will be used to identify the primary outcome measures for both the prospective, observational study as well as a two-armed crossover pilot study. We will pursue the following specific aims: 1) In a prospective, observational study, assess the relationship between the number of records open at the time of placing an order, and the risk of placing an order on the wrong patient. 2) In a two-armed crossover pilot study, compare the incidence of wrong-patient orders in a restricted environment that limits its providers to only one record open at a time to an unrestricted environment where users can open a maximum of four records at once. This project is a collaboration between Montefiore Medical Center and the Brigham and Women's Hospital, with Dr. David Bates leading an Expert Advisory Panel of national leaders in Informatics and Patient Safety research. This project directly addresses AHRQ's special emphasis notice, as it is a research project that will provide evidence to inform the safe use of health IT.

Public Health Relevance

Patient safety experts worry that CPOE systems that allow multiple patient records open at once increases the risk of wrong patient errors. When implementing IT systems, Hospital IT leaders must decide how many patient records to allow open, but to date there have been no studies that help inform this decision. We propose to do a prospective, observational study that examines the relationship between the number of records open at the time of placing an order and the risk of placing an order on the wrong patient. In addition, we propose a two-armed crossover pilot study that evaluates the wrong patient error rate when the system is configured to allow only one record open at a time compared to when the system is configured to allow a maximum of four records open at a time.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Exploratory/Developmental Grants (R21)
Project #
7R21HS023704-04
Application #
9320335
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Lomotan, Edwin A
Project Start
2014-09-30
Project End
2017-09-29
Budget Start
2015-11-10
Budget End
2017-09-29
Support Year
4
Fiscal Year
2015
Total Cost
Indirect Cost
Name
Columbia University (N.Y.)
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Adelman, Jason S; Berger, Matthew A; Rai, Amisha et al. (2017) A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites. J Am Med Inform Assoc 24:992-995