National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 118 Research Studies DisplayedKalenderian E, Bangar S, Yansane A
Identifying contributing factors associated with dental adverse events through a pragmatic electronic health record-based root cause analysis.
This study’s objective was to analyze harmful dental adverse events (AEs) to assess potential contributing factors. Harmful AEs were defined as those that resulted in temporary moderate to severe harm, required hospitalization, or resulted in permanent moderate to severe harm. The authors classified potential contributing factors according to (1) who was involved (person), (2) what were they doing (tasks), (3) what tools/technologies were they using (tools/technologies), (4) where did the event take place (environment), (5) what organizational conditions contributed to the event? (organization), (6) patient (including parents), and (7) professional-professional collaboration. A second review was conducted by a blinded panel of dental experts to confirm the presence of an AE. A total of 59 cases at 2 dental institutions had 1 or more harmful AEs. The most common harmful AE was pain (27.1%) followed by nerve injury (16.9%), hard tissue injury (15.2%), and soft tissue injury (15.2%). The most common contribution factor was the care provider (training, supervision, and fatigue at 31.5%) followed by patient ((noncompliance, unsafe practices at home, low health literacy, 17.1%), and professional-professional collaboration (15.3%).
AHRQ-funded; HS027268.
Citation: Kalenderian E, Bangar S, Yansane A .
Identifying contributing factors associated with dental adverse events through a pragmatic electronic health record-based root cause analysis.
J Patient Saf 2023 Aug 1; 19(5):305-12. doi: 10.1097/pts.0000000000001122..
Keywords: Dental and Oral Health, Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Patient Safety
Liberman AL, Wang Z, Zhu Y
Optimizing measurement of misdiagnosis-related harms using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): comparison groups to maximize SPADE validity.
The purpose of this paper was to clarify features of the Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach to accurately measure diagnostic errors to assure that researchers utilize this method to yield valid results, as well as improve the validity of SPADE and related approaches to quantify diagnostic error in medicine. The researchers describe four types of comparators (intra-group and inter-group), detailing the reason for selecting one over the other and conclusions that can be drawn from these comparative analyses.
AHRQ-funded; HS027614.
Citation: Liberman AL, Wang Z, Zhu Y .
Optimizing measurement of misdiagnosis-related harms using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): comparison groups to maximize SPADE validity.
Diagnosis 2023 Aug 1; 10(3):225-34. doi: 10.1515/dx-2022-0130..
Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Garber A, Garabedian P, Wu L
Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.
This study’s objective was to describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients. The interventions to be developed were a Diagnostic Safety Column (DSC) within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out (DTO) for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire (PDQ) to gather patient concerns about the diagnostic process. After initial refinement from an analysis, final requirements were created for 10 test cases predicted by the DSC, 18 clinician DTO participants, and 39 PDQ responses including the following: DSC configurable parameters (variables, weights) to adjust baseline risk estimates in real-time based on new clinical data collected during hospitalization; more concise DTO wording and flexibility for clinicians to conduct the DTO with or without the patient present; and integration of PDQ responses into the DSC to ensure closed-looped communication with clinicians. An analysis of focus groups confirmed that tight integration of the interventions with the EHR would be necessary to prompt clinicians to reconsider the working diagnosis in cases with elevated diagnostic error (DE) risk or uncertainty. Potential implementation barriers identified included alert fatigue and distrust of the risk algorithm (DSC); time constraints, redundancies, and concerns about disclosing uncertainty to patients (DTO); and patient disagreement with the care team's diagnosis (PDQ).
AHRQ-funded; HS026613.
Citation: Garber A, Garabedian P, Wu L .
Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.
JAMIA Open 2023 Jul; 6(2):ooad031. doi: 10.1093/jamiaopen/ooad031..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Patient Safety
Bell SK, Bourgeois F, Dong J
Patient identification of diagnostic safety blindspots and participation in "good catches" through shared visit notes.
The goal of this study was to investigate whether sharing clinical notes with patients supported identification of potential breakdowns in the diagnostic process that might be difficult for clinical staff to observe -- "diagnostic safety blindspots." Researchers analyzed patient-reported ambulatory documentation errors among patients at 3 U.S. healthcare centers. Older, female, unemployed, disabled, or sicker patients, or patients who worked in healthcare, were more likely to identify blindspots; patients who self-identified as Black, Asian, multiple races and those with less formal education as well as those who deferred decision-making to their providers were less likely to report blindspots. The researchers concluded that patients who read notes have unique insight about potential errors in their medical records and that organizations should encourage patient review of notes and create systems to track patient-reported blindspots.
AHRQ-funded; HS027367.
Citation: Bell SK, Bourgeois F, Dong J .
Patient identification of diagnostic safety blindspots and participation in "good catches" through shared visit notes.
Milbank Q 2022 Dec; 100(4):1121-65. doi: 10.1111/1468-0009.12593..
Keywords: Diagnostic Safety and Quality, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Ozonoff A, Milliren CE, Fournier K A, Milliren CE, Fournier K
Electronic surveillance of patient safety events using natural language processing.
The purpose of this study was to describe the surveillance of reportable safety events captured in hospital data including free-text clinical notes. The researchers created a training data set for a machine learning model and applied the model to complete sets of clinical notes which were then reviewed to identify safety events of interest. The study found that in Phase 1, the researchers reviewed 2,342 clinical notes of the 21,362 gathered. 125 PIV events were identified, of which 44 cases (35%) were not identified by other patient safety systems. In Phase 2 of the study, the researchers identified 440 infiltrate events of the 60,735 clinical notes collected. The study classifier provided accuracy above 90%.
AHRQ-funded; HS026246.
Citation: Ozonoff A, Milliren CE, Fournier K A, Milliren CE, Fournier K .
Electronic surveillance of patient safety events using natural language processing.
Health Informatics J 2022 Oct-Dec; 28(4):14604582221132429. doi: 10.1177/14604582221132429..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Shafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bradford A, Shofer M, Singh H
AHRQ Author: Shofer M, Singh H
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
This paper discusses Measure Dx, a new AHRQ resource that translates knowledge from diagnostic measurement research into actionable recommendations. This resource guides healthcare organizations to detect, analyze, and learn from diagnostic safety events as part of a continuous learning and feedback cycle. The goal of Measure Dx is to advance new frontiers in reducing preventable diagnostic harm to patients.
AHRQ-authored; AHRQ-funded; 233201500022I; HS027363.
Citation: Bradford A, Shofer M, Singh H .
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
Int J Qual Health Care 2022 Sep 10;34(3). doi: 10.1093/intqhc/mzac068..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality Improvement, Quality of Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Systems, Learning Health Systems
Yerneni S, Shah S, Blackley SV
Heterogeneity of drug allergies and reaction lists in two U.S. healthcare systems' electronic health records.
This study compared adverse drug reaction (ADRs) picklists for clinicians in the electronic health record (EHR) allergy list for two different healthcare institutions. The authors used data from the EHRs of patients who visited the emergency department or outpatient clinics at Brigham and Women's Hospital (BWH) and University of Colorado Hospital (UCH) from 2013-2018. They investigated the reactions on each picklist and compared the top 40 reactions at each institution, as well as the top 10 reactions within each drug class. Out of 2,160,116 patients sampled, 30% reported active drug allergies. The most commonly reported drug class allergens were similar between the two institutions, however BWH’s picklist had 48 reactions while UCH’s had 160. Twenty-nine reactions were shared by both picklists. There was a lot more granularity with UCH’s picklist so that body locality, swelling and edema were described in much greater detail than for BWH. These picklists may partially explain variations in reported ADRs across healthcare systems.
AHRQ-funded; HS025375.
Citation: Yerneni S, Shah S, Blackley SV .
Heterogeneity of drug allergies and reaction lists in two U.S. healthcare systems' electronic health records.
Appl Clin Inform 2022 May 26;13(3):741-51. doi: 10.1055/a-1862-9425..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Patient Safety
Giardina TD, Choi DT, Upadhyay DK
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
This study’s objective was to test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes in an electronic health record (EHR) system. Patients aged 18-85 years in a large integrated health system who actively used the patient portal were invited to respond to an online questionnaire if an EHR algorithm detected any recent visit following an initial primary care consultation. The authors developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to the diagnostic process based on notes review and recall of recent “at-risk” visits. The algorithm identified 1282 eligible patients, of whom 486 responded. Of the 418 patients included in the analysis, 51 patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements "The care plan the provider developed for me addressed all my medical concerns", "I trust the provider that I saw during my visit" and agreed with the statement "I did not have a good feeling about my visit".
AHRQ-funded; HS027363; HS025474.
Citation: Giardina TD, Choi DT, Upadhyay DK .
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
J Am Med Inform Assoc 2022 May 11;29(6):1091-100. doi: 10.1093/jamia/ocac036..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Patient Safety
Pruitt ZM, Howe JL, Hettinger AZ
Emergency physician perceptions of electronic health record usability and safety.
Investigators sought to identify emergency physicians' perceived electronic health record (EHR) usability and safety strengths and shortcomings across major EHR vendor products. They found that the 3 most commonly discussed usability topics were Workflow Support (shortcoming), Visual Display (strength), and Data Entry. Fourteen cross-hospital/cross-vendor themes, 6 vendor-specific themes, and 4 hospital-specific themes emerged as well.
AHRQ-funded; HS025136.
Citation: Pruitt ZM, Howe JL, Hettinger AZ .
Emergency physician perceptions of electronic health record usability and safety.
J Patient Saf 2021 Dec 1;17(8):e983-e87. doi: 10.1097/pts.0000000000000849..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Reese TJ, Del Fiol G, Morgan K
A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: design and usability study.
Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric. This study aimed to design and examine the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs.
AHRQ-funded; HS026198.
Citation: Reese TJ, Del Fiol G, Morgan K .
A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: design and usability study.
JMIR Hum Factors 2021 Oct 26;8(4):e28618. doi: 10.2196/28618..
Keywords: Blood Thinners, Medication: Safety, Medication, Clinical Decision Support (CDS), Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Patient Safety
Fong A, Adams K, Samarth A
AHRQ Author: Chappel T, Grace E, Terrillion S
Assessment of automating safety surveillance from electronic health records: Analysis for the quality and safety review system.
Researchers provided a heuristic assessment of the feasibility of automatically populating the Quality and Safety Review System (QSRS) questions from electronic health record (EHR) data. They developed the Relative Abstraction Complexity Framework to assess relative complexity of data abstraction questions. Their results suggested that Blood and Hospital Acquired Infections-Clostridium Difficile Infection (HAI-CDI) modules would be relatively easier to automate, whereas Surgery and HAI-Surgical Site Infection would be more difficult to automate.
AHRQ-authored; AHRQ-funded; 290201400008I.
Citation: Fong A, Adams K, Samarth A .
Assessment of automating safety surveillance from electronic health records: Analysis for the quality and safety review system.
J Patient Saf 2021 Sep 1;17(6):e524-e28. doi: 10.1097/pts.0000000000000402..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Watterson TL, Stone JA, Brown R
CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.
Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic's electronic health record (EHR) to the outpatient pharmacy's software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.
AHRQ-funded; HS025793.
Citation: Watterson TL, Stone JA, Brown R .
CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.
J Am Med Inform Assoc 2021 Jul 14;28(7):1526-33. doi: 10.1093/jamia/ocab038..
Keywords: Medication: Safety, Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery
Wu P, Nelson SD, Zhao J
DDIWAS: high-throughput electronic health record-based screening of drug-drug interactions.
In this study, the investigators developed and evaluated Drug-Drug Interaction Wide Association Study (DDIWAS). This novel method detected potential drug-drug interactions (DDIs) by leveraging data from the electronic health record (EHR) allergy list. The investigators concluded that they demonstrated the value of incorporating information mined from existing allergy lists to detect DDIs in a real-world clinical setting. They indicate that since allergy lists are routinely collected in EHRs, DDIWAS has the potential to detect and validate DDI signals across institutions.
AHRQ-funded; HS026395.
Citation: Wu P, Nelson SD, Zhao J .
DDIWAS: high-throughput electronic health record-based screening of drug-drug interactions.
J Am Med Inform Assoc 2021 Jul 14;28(7):1421-30. doi: 10.1093/jamia/ocab019..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety, Patient Safety
Enayati M, Sir M, Zhang X
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
This study’s objective will be to identify variables associated with diagnostic errors in emergency departments using large-scale EHR data and machine learning techniques. It will use trigger algorithms with electronic health record (EHR) data repositories to generate a large data set of records that are labeled trigger-positive or trigger-negative, depending on if they meet certain criteria. This study will be conducted by 2 academic medical centers with affiliated community hospitals.
AHRQ-funded; HS027363; HS026622.
Citation: Enayati M, Sir M, Zhang X .
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
JMIR Res Protoc 2021 Jun 14;10(6):e24642. doi: 10.2196/24642..
Keywords: Emergency Department, Diagnostic Safety and Quality, Patient Safety, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kandaswamy S, Pruitt Z, Kazi S
Clinician perceptions on the use of free-text communication orders.
The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. The investigators concluded that clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks.
AHRQ-funded; HS025136; HS024755.
Citation: Kandaswamy S, Pruitt Z, Kazi S .
Clinician perceptions on the use of free-text communication orders.
Appl Clin Inform 2021 May;12(3):484-94. doi: 10.1055/s-0041-1731002..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Electronic Health Records (EHRs), Medication: Safety, Medication, Patient Safety, Communication, Provider: Clinician, Provider, Risk
Classen DC, Munier W, Verzier N
AHRQ Author: Munier W, Eldridge N, Brady PJ, Helwig A, Battles J
Measuring patient safety: the Medicare Patient Safety Monitoring System (past, present, and future).
This review article discusses the development, strengths and limitations, and future of the Medicare Patient Safety Monitoring System (MPSMS), which was created more than 10 years ago. MPSMS is a chart review-based national patient safety surveillance system that provides rates of 21 specific hospital inpatient adverse event measures, which are divided into 4 clinical domains (general, hospital-acquired infections, post-procedure adverse events, and adverse drug events). The 2014 MPSMS national sample was drawn from 1109 hospitals and includes approximately 20,000 medical records of patients admitted to the hospital for at least 1 of 4 conditions: congestive heart failure, acute myocardial infarction, pneumonia, and major surgical procedures as defined by the Centers for Medicare and Medicaid Services Surgical Care Improvement Project. The MSPMS is now undergoing a major transformation to capture additional types of adverse events, and is being renamed the Quality and Safety Review System (QSRS). Data will be electronically imported and will be updated and evolved over time to incorporate expanded standardized data available from electronic health records.
AHRQ-authored.
Citation: Classen DC, Munier W, Verzier N .
Measuring patient safety: the Medicare Patient Safety Monitoring System (past, present, and future).
J Patient Saf 2021 Apr 1;17(3):e234-3240. doi: 10.1097/pts.0000000000000322..
Keywords: Patient Safety, Medicare, Medical Errors, Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT)
Alvarez-Arango S, Yerneni S, Tang O
Vancomycin hypersensitivity reactions documented in electronic health records.
This study’s objective is to describe vancomycin hypersensitivity reaction (HSR) epidemiology in hospitals documented in electronic health records. Vancomycin is the most commonly prescribed antimicrobial in US hospitals. A cross-sectional study of patients with 1 or more encounter from 2017 to 2019 and an electronic health record vancomycin drug allergy label (DAL) in 2 US health care systems was conducted. Prevalence and trends of vancomycin DALs and assessed active DALs by HSR phenotype was determined. Out of almost 4.5 million patients, 14,426 (0.3%) had a vancomycin DAL with 18,761 documented reactions. Out of those 18,761 vancomycin HSRs, 42.1% were immediate phenotypes and 20.7% were delayed phenotypes. Common reactions were rash and red man syndrome (RMS). Anaphylaxis occurred in 6% of HSRs. RMS reaction was more likely for males and less likely for Blacks.
AHRQ-funded; HS025375.
Citation: Alvarez-Arango S, Yerneni S, Tang O .
Vancomycin hypersensitivity reactions documented in electronic health records.
J Allergy Clin Immunol Pract 2021 Feb;9(2):906-12. doi: 10.1016/j.jaip.2020.09.027..
Keywords: Antibiotics, Medication, Medication: Safety, Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Patient Safety
Lacson R, Cochon L, Ching PR
Integrity of clinical information in radiology reports documenting pulmonary nodules.
Researchers sought to quantify the integrity, measured as completeness and concordance with a thoracic radiologist, of documenting pulmonary nodule characteristics in CT reports, and to assess impact on making follow-up recommendations. Their retrospective cohort study was performed at an academic medical center and natural language processing was used on radiology reports of CT scans of chest, abdomen, or spine to assess presence of pulmonary nodules. They found that essential pulmonary nodule characteristics were under-reported, potentially impacting recommendations for pulmonary nodule follow-up. They concluded that the lack of documentation of pulmonary nodule characteristics in radiology reports was common, with the potential for compromising patient care and clinical decision support tools.
AHRQ-funded; HS024722.
Citation: Lacson R, Cochon L, Ching PR .
Integrity of clinical information in radiology reports documenting pulmonary nodules.
J Am Med Inform Assoc 2021 Jan 15;28(1):80-85. doi: 10.1093/jamia/ocaa209..
Keywords: Imaging, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Griffey RT, Schneider RM, Todorov AA
The emergency department trigger tool: validation and testing to optimize yield.
Researchers validated the emergency department trigger tool (EDTT) in an independent sample and compared record selection approaches to optimize yield for quality improvement. In this single-site study of the EDTT, they observed high levels of validity in trigger selection, yield, and representativeness of adverse events, with yields that are superior to estimates for traditional approaches to adverse event detection. Record selection using weighted triggers outperformed a trigger count threshold approach and far outperformed random sampling from records with at least one trigger. They concluded that the EDTT is a promising efficient and high-yield approach for detecting all-cause harm to guide quality improvement efforts in the emergency department.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
The emergency department trigger tool: validation and testing to optimize yield.
Acad Emerg Med 2020 Dec;27(12):1279-90. doi: 10.1111/acem.14101..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Adverse Events, Patient Safety, Quality Improvement, Quality of Care
Salmasian H, Blanchfield BB, Joyce K
Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.
Wrong-patient order entry (WPOE) errors have a high potential for harm; these errors are particularly frequent wherever workflows are complex and multitasking and interruptions are common, such as in the emergency department (ED). The purpose of this study was to evaluate whether the use of noninterruptive display of patient photographs in the banner of the electronic health record (EHR) is associated with a decreased rate of WPOE errors.
AHRQ-funded; HS024713.
Citation: Salmasian H, Blanchfield BB, Joyce K .
Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.
AMA Netw Open 2020 Nov 2;3(11):e2019652. doi: 10.1001/jamanetworkopen.2020.19652..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Patient Safety, Diagnostic Safety and Quality
Lacson R, Healey MJ, Cochon LR
Unscheduled radiologic examination orders in the electronic health record: a novel resource for targeting ambulatory diagnostic errors in radiology.
The purpose of this study was to assess the prevalence of unscheduled radiologic examination orders in an electronic health record and to assess the proportion of unscheduled orders that are clinically necessary. Unscheduled radiologic examination orders were retrieved for seven modalities: computed tomography, magnetic resonance imaging, ultrasound, obstetric ultrasound, bone densitometry, mammography, and fluoroscopy. Findings showed that large numbers of radiologic examination orders remain unscheduled in the electronic health record. Identifying and performing clinically necessary unscheduled radiologic examination orders may help reduce diagnostic errors related to diagnosis and treatment delays and enhance patient safety.
AHRQ-funded; HS024722.
Citation: Lacson R, Healey MJ, Cochon LR .
Unscheduled radiologic examination orders in the electronic health record: a novel resource for targeting ambulatory diagnostic errors in radiology.
J Am Coll Radiol 2020 Jun;17(6):765-72. doi: 10.1016/j.jacr.2019.12.021..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Imaging, Patient Safety
Singh H, Sittig DF
A sociotechnical framework for Safety-Related Electronic Health Record Research reporting: the SAFER Reporting Framework.
Electronic health record (EHR)-based interventions to improve patient safety are complex and sensitive to who, what, where, why, when, and how they are delivered. This article proposed a methodological reporting framework for EHR interventions targeting patient safety and built on an 8-dimension sociotechnical model previously developed by the authors for design, development, implementation, use, and evaluation of health information technology.
AHRQ-funded; HS022087; HS024459; HS017820.
Citation: Singh H, Sittig DF .
A sociotechnical framework for Safety-Related Electronic Health Record Research reporting: the SAFER Reporting Framework.
Ann Intern Med 2020 Jun 2;172(11 Suppl):S92-s100. doi: 10.7326/m19-0879..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Communication
Furukawa MF, Eldridge N, Wang Y
AHRQ Author: Furukawa MF, Eldridge N
Electronic health record adoption and rates of in-hospital adverse events.
Researchers examined the association of hospitals' electronic health record (EHR) adoption and occurrence rates of adverse events among exposed patients. The study included patients hospitalized for acute cardiovascular disease, pneumonia, or conditions requiring surgery. The researchers found that patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.
AHRQ-authored.
Citation: Furukawa MF, Eldridge N, Wang Y .
Electronic health record adoption and rates of in-hospital adverse events.
J Patient Saf 2020 Jun;16(2):137-42. doi: 10.1097/pts.0000000000000257..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Events, Inpatient Care, Hospitals, Patient Safety
Soleimani J, Pinevich Y, Barwise AK
Feasibility and reliability testing of manual electronic health record reviews as a tool for timely identification of diagnostic error in patients at risk.
Although diagnostic error (DE) is a significant problem, it remains challenging for clinicians to identify it reliably and to recognize its contribution to the clinical trajectory of their patients. The purpose of this work was to evaluate the reliability of real-time electronic health record (EHR) reviews using a search strategy for the identification of DE as a contributor to the rapid response team (RRT) activation. Early and accurate recognition of critical illness is of paramount importance.
AHRQ-funded; HS026609.
Citation: Soleimani J, Pinevich Y, Barwise AK .
Feasibility and reliability testing of manual electronic health record reviews as a tool for timely identification of diagnostic error in patients at risk.
Appl Clin Inform 2020 May;11(3):474-82. doi: 10.1055/s-0040-1713750..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety