Ten strategies to improve management of abnormal test result alerts in the electronic health record.
Ten strategies to improve management of abnormal test result alerts in the electronic health record.
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DOI：
10.1097/pts.0b013e3181ddf652
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发表时间：
2010-06
影响因子：
2.2
通讯作者：
Sittig DF
中科院分区：
文献类型：
--
作者：
Singh H;Wilson L;Reis B;Sawhney MK;Espadas D;Sittig DF
遗漏的异常检测结果是一个重大的患者安全问题，特别是在门诊设置。不及时沟通和跟进异常诊断测试结果可能导致诊断错误、不良事件和责任索赔。1Y4集成在电子健康记录（EHRs）中的自动警报通知系统提供了一个潜在的解决方案。5,6例如，通过Balerts（对显著异常或关键测试结果的计算机通知）交流异常临床信息可能有助于快速审查患者信息。电脑化病人记录系统（CPRS）是所有退伍军人事务部（VA）设施使用的综合电子病历，它使用自动通知系统（View Alert系统）来传达异常诊断测试结果（图1）。尽管有这种自动通知系统，我们最近发现7%的异常门诊实验室结果和8%的异常影像学结果在30天内缺乏随访。8,9因此，电子警报并不能消除错过成绩的问题。我们还发现临床医生不承认18%的诊断成像警报和10%的诊断实验室警报。一些临床医生收到了大量的警报（例如，每天950个），其中一些他们从未审查过。许多临床医生对电子病历中帮助管理警报的特定特征的认识不一致。改善关键检测结果报告是联合委员会的一项国家患者安全目标。此外，VA最近发布了一项指令，强调了与从业者和患者沟通检测结果的及时性，并进一步建议每个VA设施解决订购和报告检测结果的问题。通过我们正在进行的定量和定性评估工作，我们确定了临床医生可以立即使用的10种策略，以改善与异常测试结果相关的自动通知的管理。我们根据2个图表回顾研究、1个焦点小组研究、12个深入任务分析会议确定了这些策略，这些会议是我们在VA国家患者安全中心资助的一个为期2年的项目中进行的。随后，我们获得了许多初级保健医生的非正式反馈，他们同意采用这些策略可以帮助他们更可靠、更有效地管理警报。与我们最近提出的电子病历安全使用模型一致，这些策略被分为3组：以临床医生（用户）为中心，以人机界面为中心，以沟通和工作流程为中心。
Missed abnormal test results are a significant patient safety problem, especially in the outpatient setting. Failure to communicate and follow-up on abnormal diagnostic test results can lead to diagnostic errors, adverse events, and liability claims. 1Y4 Automated alert notification systems integrated within electronic health records (EHRs) offer a potential solution. 5, 6 For instance, communication of abnormal clinical information through Balerts [(computerized notifications of significantly abnormal or critical test results) can potentially facilitate rapid review of patient information. 7 The Computerized Patient Record System (CPRS), an integrated EHR used at all Veterans Affairs (VA) facilities, uses an automated notification system (the View Alert system) to communicate abnormal diagnostic test results (Fig. 1). Despite this automated notification system, we recently found that 7% of abnormal outpatient laboratory results and 8% of abnormal imaging results lacked followup within 30 days. 8, 9 Therefore, electronic alerts do not eliminate the problem of missed results. We also found that clinicians did not acknowledge 18% of diagnostic imaging alerts and 10% of diagnostic laboratory alerts. Some clinicians received an overwhelming number of alerts (eg, 950 per day), some of which they never reviewed. Many clinicians had inconsistent knowledge of specific features in the EHR to help manage alerts.Improving critical test result reporting is a national patient safety goal of the Joint Commission. 10 Additionally, the VA recently released a directive emphasizing timeliness of test result communication to practitioners and patients and further recommended that each VA facility address ordering and reporting test results. 11 With our ongoing quantitative and qualitative evaluation work, we have identified 10 strategies that clinicians can use immediately to improve their management of automated notifications related to abnormal test results. We identified these strategies on the basis of 2 chart review studies, 8, 9 a focus group study, 12 and in-depth task analysis sessions13 that we conducted over the course of a 2-year project funded by the VA National Center for Patient Safety. Subsequently, we obtained informal feedback from numerous primary care physicians who agreed that adoption of these strategies could help them manage alerts more reliably and effectively. Consistent with our recently proposed model for safe EHR use, 14 the strategies are divided into 3 groups: clinician (user) centered, human-computer interface centered, and communication and workflow centered.