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系统会增加错误患者的风险。最近对首席医疗信息官进行的一项全国性调查表明，对于允许立即打开的最安全的患者记录数量缺乏共识，目前IT领导层允许打开的记录数量存在明显的异质性。我们的应用程序将是第一项研究，为IT领导者提供有关同时打开不同数量记录时错误患者错误风险的数据，这将有助于他们就CPOE系统的最佳配置做出更明智的决定。我们提出了一项大型观察性研究，以检查打开的记录数量与错误患者错误风险之间的关系（目标1）。然而，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有可能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混淆观察性研究。为了解决混淆的威胁，我们还提出了一个双臂交叉试点研究，其中CPOE系统将被配置为限制大约一半的住院床位一次向一名患者打开的记录数量（“限制环境”），而另一半住院病床则会获准一次最多开设四个纪录（“无限制环境”）;在试点研究中途，这些配置将被逆转（目标2）。比较受限制和不受限制队列中的错误患者错误率将有助于进一步量化同时打开多个记录的风险。这项研究是由一个创新的工具，用于识别错误的病人电子订单，开发和验证蒙蒂菲奥里医疗中心。该工具在Montefiore平均每天识别14例患者错误，将用于识别前瞻性观察性研究和双臂交叉初步研究的主要结局指标。我们将追求以下具体目标：1）在一项前瞻性观察性研究中，评估下订单时打开的记录数量与下错误患者订单的风险之间的关系。2)在一项双臂交叉试点研究中，比较了在“受限环境”和“无限制环境”中错误医嘱的发生率，前者限制其提供者一次只能打开一个记录，而后者用户一次最多可以打开四个记录。该项目是Montefiore医疗中心和布里格姆妇女医院之间的合作，由大卫贝茨博士领导一个由信息学和患者安全研究领域的国家领导人组成的专家咨询小组。该项目直接针对AHRQ的特别强调通知，因为它是一个研究项目，将提供证据，告知安全使用卫生信息技术。

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.