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

描述（由申请人提供）：患者安全专家担心，允许同时打开多个患者记录的CPOE系统会增加患者错误的风险。最近对首席医疗信息官进行的一项全国调查表明，对于允许同时开放的最安全的患者记录数量缺乏共识，IT领导层目前允许开放的记录数量明显存在差异。我们的应用程序将是第一个为IT领导者提供在一次打开不同数量的记录时错误患者错误风险的数据的研究，这将帮助他们在CPOE系统的最佳配置方面做出更明智的决定。我们建议进行一项大型观察性研究，以检验开放记录数量与错误患者错误风险之间的关系（目的1）。然而，有可能的是，提供者更有可能一次打开多个记录的临床环境也可能是更容易发生错误患者错误的临床环境，并且临床环境的类型或其他因素可能会混淆观察性研究。为了解决混淆的威胁，我们还提出了一项双臂交叉试点研究，其中CPOE系统将被配置为在大约一半的住院病床（“限制环境”）中限制一次对一名患者开放记录的数量，而另一半住院病床将被允许一次最多打开四个记录（“无限制环境”）；在试点研究的中途，这些配置将被逆转（目标2）。对受限制和不受限制队列的错误率进行比较，将有助于进一步量化同时打开多个记录的风险。这项研究是由Montefiore医疗中心开发并验证的一种用于识别错误患者电子订单的创新工具实现的。该工具在Montefiore平均每天识别14个错误的患者错误，将用于确定前瞻性观察性研究和双臂交叉试点研究的主要结果测量。我们将追求以下具体目标：1)在一项前瞻性观察性研究中，评估下单时打开的记录数量与错误患者下单风险之间的关系。2)在一项双臂交叉试点研究中，比较在“受限环境”（限制提供者一次只能打开一条记录）和“无限制环境”（用户一次最多可以打开四条记录）下错误病人订单的发生率。该项目是Montefiore医学中心和Brigham妇女医院的合作项目，由David Bates博士领导一个由信息学和患者安全研究方面的国家领导人组成的专家咨询小组。该项目直接回应了AHRQ的特别强调通知，因为它是一个研究项目，将为卫生信息技术的安全使用提供证据。

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.