Effects on wrong-patient errors by limiting access to concurrently open ERH charts: A preliminary systematic mapping and synthesis review
Notice bibliographique
Résumé
Abstract Background Several recent outcome studies have been published looking at the effects of restricting electronic health record (EHR) user interfaces to limit the number of concurrently accessible patient records. Strong recommendations have been in place for several years to have user interfaces constrained to only display one patient chart at a time in order to reduce the risk of data (documentation, orders) being entered on the wrong patient (Joint Commission, 2015; ONC, 2016). This recommendation was made based on expert opinion rather than objective information, raising the question whether the accumulating evidence supports continued implementation of such chart access restrictions. Objectives This work reports a systematic mapping and synthesis review addressing research questions, “What is the evidence that restricting the number of concurrently open records reduces errors? (RQ1), “How effective is restriction of concurrently open charts at reducing wrong-patient errors? (RQ2), and “What additional inquiry is needed to make evidence-based policy decisions about restricting concurrent chart access? (RQ3). Methods A systematic search of CINAHL, PubMed, and Web of Science databases was performed with full search string specification to retrieve a result set that is the conjunction of result sets for concepts of EHR, concurrently open charts , and medical error . Of 407 studies identified and screened, five were eligible for inclusion in the qualitative synthesis review, and three were amenable to data extraction and pooled effect size calculation. Results None of the studies included for review found evidence of statistically significant change in wrong-patient error rates associated with implementing restriction in the number of patient records allowed to be open concurrently in the EHR. The combined OR for the pooled studies was 1.02 (95% CI 0.90 – 1.15) with low estimates for inter-study heterogeneity and no indication of publication bias. Conclusion There is no evidence that restricting the number of concurrently open records reduces errors (RQ1). It is not possible to definitively answer RQ2, but the magnitude of any yet to be detected beneficial effect that might be lost with lifting of chart access restriction can be no greater than an absolute risk increase of 33 errors per 100,000 ordering sessions. While it has been claimed that restricting the number of concurrently open EHR records is necessary for patient safety, the present review demonstrates that it is insufficient to attain a measurable improvement in error rates. Additional investigation of the usability and human factors aspects of EHR configuration decisions as well as knowledge of the impacts on clinical workflows will be necessary to provide policymakers, operational leaders, and practitioners with insight into the nature of the threats and opportunities with respect to safety, as well as the strengths and weaknesses of potential interventions.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,055 | 0,205 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,010 | 0,016 |
| Bibliométrie | 0,020 | 0,015 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,006 | 0,005 |
| Science ouverte | 0,003 | 0,004 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».