Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission
Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission
复制标题
研究论文：防止遗漏错误的“推论顺序”随机试验
DOI：
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
C. McDonald
中科院分区：
文献类型：
--
作者：
J. Overhage;W. Tierney;Xiao;C. McDonald
目的
遗漏错误是系统故障的常见原因。医生经常无法安排监测/改善其他测试或治疗效果所需的测试或治疗。作者假设，在医生撰写医嘱时提供的自动化、基于指南的提醒可以减少这些遗漏。
设计
本研究在一家公立教学医院的住院普通内科病房进行。来自印第安纳州大学医学院的教职员工，他们使用电脑工作站写订单，被随机分为干预组和对照组。当干预医生为87个选定的测试或治疗中的一个写下命令时，计算机建议需要检测或改善触发命令的不良反应的推论命令。医生可以接受或拒绝这些建议。
结果
在为期6个月的试验中，向48名干预医生提供了关于推论命令的提醒，并向41名对照医生提供了提示。干预医生在收到提醒时，有46.3%的情况下订购了建议的推论订单，而对照医生的依从性为21.9%（p < 0.0001）。医生们在接受建议的医嘱时会有所区别，欣然接受一些医嘱，拒绝另一些医嘱。与对照组相比，药剂师和医生在干预中发起的干预少了三分之一。
结论
这项研究表明，医生工作站，链接到一个全面的电子病历，可以是一个有效的手段，减少遗漏的错误，提高遵守实践指南。
OBJECTIVE
Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/ameliorate the effects of other tests or treatments. The authors hypothesized that automated, guideline-based reminders to physicians, provided as they wrote orders, could reduce these omissions.
DESIGN
The study was performed on the inpatient general medicine ward of a public teaching hospital. Faculty and housestaff from the Indiana University School of Medicine, who used computer workstations to write orders, were randomized to intervention and control groups. As intervention physicians wrote orders for 1 of 87 selected tests or treatments, the computer suggested corollary orders needed to detect or ameliorate adverse reactions to the trigger orders. The physicians could accept or reject these suggestions.
RESULTS
During the 6-month trial, reminders about corollary orders were presented to 48 intervention physicians and withheld from 41 control physicians. Intervention physicians ordered the suggested corollary orders in 46.3% of instances when they received a reminder, compared with 21.9% compliance by control physicians (p < 0.0001). Physicians discriminated in their acceptance of suggested orders, readily accepting some while rejecting others. There were one third fewer interventions initiated by pharmacists with physicians in the intervention than control groups.
CONCLUSION
This study demonstrates that physician workstations, linked to a comprehensive electronic medical record, can be an efficient means for decreasing errors of omissions and improving adherence to practice guidelines.
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印第安纳波利斯患者护理和研究网络的设计和实施。
DOI：
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发表时间：
1995
期刊：
Bulletin of the Medical Library Association
影响因子：
--
作者：
Overhage,JM;Tierney,WM;McDonald,CJ
通讯作者：
McDonald,CJ
DOI：
10.1001/jama.274.1.35
发表时间：
1995-07
期刊：
JAMA
影响因子：
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作者：
L. Leape;D. Bates;D. Cullen;J. Cooper;H. Demonaco;T. Gallivan;R. Hallisey;J. Ives;N. Laird;G. Laffel
通讯作者：
L. Leape;D. Bates;D. Cullen;J. Cooper;H. Demonaco;T. Gallivan;R. Hallisey;J. Ives;N. Laird;G. Laffel
基于计算机的医嘱输入：最先进的技术。
DOI：
10.1136/jamia.1994.95236142
发表时间：
1994
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Sittig,DF;Stead,WW
通讯作者：
Stead,WW
影响因子：
1.9
作者：
ZEGER, SL;LIANG, KY;ALBERT, PS
通讯作者：
ALBERT, PS