Dataset Information

Assessment of Unintentional Duplicate Orders by Emergency Department Clinicians Before and After Implementation of a Visual Aid in the Electronic Health Record Ordering System.

ABSTRACT:

Importance

Electronic health records allow teams of clinicians to simultaneously care for patients, but an unintended consequence is the potential for duplicate orders of tests and medications.

Objective

To determine whether a simple visual aid is associated with a reduction in duplicate ordering of tests and medications.

Design, setting, and participants

This cohort study used an interrupted time series model to analyze 184?694 consecutive patients who visited the emergency department (ED) of an academic hospital with 55?000 ED visits annually. Patient visits occurred 1 year before and after each intervention, as follows: for laboratory orders, from August 13, 2012, to August 13, 2014; for medication orders, from February 3, 2013, to February 3, 2015; and for radiology orders, from December 12, 2013, to December 12, 2015. Data were analyzed from April to September 2019.

Exposure

If an order had previously been placed during the ED visit, a red highlight appeared around the checkbox of that order in the computerized provider order entry system.

Main outcomes and measures

Number of unintentional duplicate laboratory, medication, and radiology orders.

Results

A total of 184?694 patients (mean [SD] age, 51.6 [20.8] years; age range, 0-113.0 years; 99?735 [54.0%] women) who visited the ED were analyzed over the 3 overlapping study periods. After deployment of a noninterruptive nudge in electronic health records, there was an associated 49% decrease in the rate of unintentional duplicate orders for laboratory tests (incidence rate ratio, 0.51; 95% CI, 0.45-0.59), from 4485 to 2731 orders, and an associated 40% decrease in unintentional duplicate orders of radiology tests (incidence rate ratio, 0.60; 95% CI, 0.44-0.82), from 956 to 782 orders. There was not a statistically significant change in unintentional duplicate orders of medications (incidence rate ratio, 1.17; 95% CI, 0.52-2.61), which increased from 225 to 287 orders. The nudge eliminated an estimated 17?936 clicks in our electronic health record.

Conclusions and relevance

In this interrupted time series cohort study, passive visual cues that provided just-in-time decision support were associated with reductions in unintentional duplicate orders for laboratory and radiology tests but not in unintentional duplicate medication orders.

SUBMITTER: Horng S

PROVIDER: S-EPMC6902748 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Assessment of Unintentional Duplicate Orders by Emergency Department Clinicians Before and After Implementation of a Visual Aid in the Electronic Health Record Ordering System.

Horng Steven S Joseph Joshua W JW Calder Shelley S Stevens Jennifer P JP O'Donoghue Ashley L AL Safran Charles C Nathanson Larry A LA Leventhal Evan L EL

JAMA network open 20191202 12

<h4>Importance</h4>Electronic health records allow teams of clinicians to simultaneously care for patients, but an unintended consequence is the potential for duplicate orders of tests and medications.<h4>Objective</h4>To determine whether a simple visual aid is associated with a reduction in duplicate ordering of tests and medications.<h4>Design, setting, and participants</h4>This cohort study used an interrupted time series model to analyze 184 694 consecutive patients who visited the emergenc ...[more]

PMID: 31790566

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Dataset Information

Assessment of Unintentional Duplicate Orders by Emergency Department Clinicians Before and After Implementation of a Visual Aid in the Electronic Health Record Ordering System.

Importance

Objective

Design, setting, and participants

Exposure

Main outcomes and measures

Results

Conclusions and relevance

Publications

Assessment of Unintentional Duplicate Orders by Emergency Department Clinicians Before and After Implementation of a Visual Aid in the Electronic Health Record Ordering System.

Similar Datasets

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