Assess Risk of Wrong Patient Errors in an EMR that Allows Multiple Records Open

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DESCRIPTION (provided by applicant): 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.