Limiting the number of open charts does not impact wrong patient order entry in the emergency department
Abstract Objective We sought to examine the impact of limiting the number of open active charts on wrong patient order entry events among 13 emergency departments (EDs) in a large integrated health system. Methods A retrospective chart review of all orders placed between September 2017 and September...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-10-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12129 |
| _version_ | 1818302735677652992 |
|---|---|
| author | Christina Canfield Chiedozie Udeh Heather Blonsky Aaron C. Hamilton Baruch S. Fertel |
| author_facet | Christina Canfield Chiedozie Udeh Heather Blonsky Aaron C. Hamilton Baruch S. Fertel |
| author_sort | Christina Canfield |
| collection | DOAJ |
| description | Abstract Objective We sought to examine the impact of limiting the number of open active charts on wrong patient order entry events among 13 emergency departments (EDs) in a large integrated health system. Methods A retrospective chart review of all orders placed between September 2017 and September 2019 was conducted. The rate of retract and reorder events was analyzed with no overlap in both the period pre‐ and post‐intervention period. Secondary analysis of error rate by clinician type, clinician patient load, and time of day was performed. Results The order retraction rate was not improved pre‐ and post‐intervention. Retraction rates varied by clinician type with residents retracting more often than physicians (odds ratio [OR] = 1.443 [1.349, 1.545]). Advanced practice providers also showed a slightly higher rate than physicians (OR = 1.114 [1.071, 1.160]). Pharmacists showed very low rates compared to physicians (OR = 0.191 [0.048, 0.764]). Time of day and staffing ratios appear to be a factor with wrong patient order entry rates slightly lower during the night (1900–0700) than the day (OR 0.958 [0.923, 0.995]), and increasing slightly with every additional patient per provider (OR 1.019 [1.005, 1.032]). The Academic Medical Center had more retractions that the other EDs. OR for the various ED types compared to the Academic Medical Center included Community (OR 0.908 [0.859, 0.959]), Teaching Hospitals (OR 0.850 [0.802, 0.900]), and Freestanding (OR 0.932 [0.864, 1.006]). Conclusions Limiting the number of open active charts from 4 to 2 did not significantly reduce the incidence of wrong patient order entry. Further investigation into other factors contributing to order entry errors is warranted. |
| first_indexed | 2024-12-13T05:43:38Z |
| format | Article |
| id | doaj.art-f348d0dda8dc417ba71a2396ac7c2a77 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-12-13T05:43:38Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-f348d0dda8dc417ba71a2396ac7c2a772022-12-21T23:57:43ZengWileyJournal of the American College of Emergency Physicians Open2688-11522020-10-01151071107710.1002/emp2.12129Limiting the number of open charts does not impact wrong patient order entry in the emergency departmentChristina Canfield0Chiedozie Udeh1Heather Blonsky2Aaron C. Hamilton3Baruch S. Fertel4Medical Operations Cleveland Clinic Health System Cleveland Ohio USADepartment of Cardiothoracic Anesthesia & Intensive Care and Resuscitation Cleveland Clinic Health System Cleveland Clinic Lerner College of Medicine Cleveland Ohio USAEnterprise Quality and Safety Cleveland Clinic Health System Cleveland Ohio USADepartment of Hospital Medicine & Enterprise Quality and Safety Cleveland Clinic Health System Cleveland Clinic Lerner College of Medicine Cleveland Ohio USADepartment of Emergency Medicine & Enterprise Quality and Safety Cleveland Clinic Health System Cleveland Clinic Lerner College of Medicine Cleveland Ohio USAAbstract Objective We sought to examine the impact of limiting the number of open active charts on wrong patient order entry events among 13 emergency departments (EDs) in a large integrated health system. Methods A retrospective chart review of all orders placed between September 2017 and September 2019 was conducted. The rate of retract and reorder events was analyzed with no overlap in both the period pre‐ and post‐intervention period. Secondary analysis of error rate by clinician type, clinician patient load, and time of day was performed. Results The order retraction rate was not improved pre‐ and post‐intervention. Retraction rates varied by clinician type with residents retracting more often than physicians (odds ratio [OR] = 1.443 [1.349, 1.545]). Advanced practice providers also showed a slightly higher rate than physicians (OR = 1.114 [1.071, 1.160]). Pharmacists showed very low rates compared to physicians (OR = 0.191 [0.048, 0.764]). Time of day and staffing ratios appear to be a factor with wrong patient order entry rates slightly lower during the night (1900–0700) than the day (OR 0.958 [0.923, 0.995]), and increasing slightly with every additional patient per provider (OR 1.019 [1.005, 1.032]). The Academic Medical Center had more retractions that the other EDs. OR for the various ED types compared to the Academic Medical Center included Community (OR 0.908 [0.859, 0.959]), Teaching Hospitals (OR 0.850 [0.802, 0.900]), and Freestanding (OR 0.932 [0.864, 1.006]). Conclusions Limiting the number of open active charts from 4 to 2 did not significantly reduce the incidence of wrong patient order entry. Further investigation into other factors contributing to order entry errors is warranted.https://doi.org/10.1002/emp2.12129electronic health recordemergency departmentinformation technologypatient safetyprescribing errorsquality improvement |
| spellingShingle | Christina Canfield Chiedozie Udeh Heather Blonsky Aaron C. Hamilton Baruch S. Fertel Limiting the number of open charts does not impact wrong patient order entry in the emergency department Journal of the American College of Emergency Physicians Open electronic health record emergency department information technology patient safety prescribing errors quality improvement |
| title | Limiting the number of open charts does not impact wrong patient order entry in the emergency department |
| title_full | Limiting the number of open charts does not impact wrong patient order entry in the emergency department |
| title_fullStr | Limiting the number of open charts does not impact wrong patient order entry in the emergency department |
| title_full_unstemmed | Limiting the number of open charts does not impact wrong patient order entry in the emergency department |
| title_short | Limiting the number of open charts does not impact wrong patient order entry in the emergency department |
| title_sort | limiting the number of open charts does not impact wrong patient order entry in the emergency department |
| topic | electronic health record emergency department information technology patient safety prescribing errors quality improvement |
| url | https://doi.org/10.1002/emp2.12129 |
| work_keys_str_mv | AT christinacanfield limitingthenumberofopenchartsdoesnotimpactwrongpatientorderentryintheemergencydepartment AT chiedozieudeh limitingthenumberofopenchartsdoesnotimpactwrongpatientorderentryintheemergencydepartment AT heatherblonsky limitingthenumberofopenchartsdoesnotimpactwrongpatientorderentryintheemergencydepartment AT aaronchamilton limitingthenumberofopenchartsdoesnotimpactwrongpatientorderentryintheemergencydepartment AT baruchsfertel limitingthenumberofopenchartsdoesnotimpactwrongpatientorderentryintheemergencydepartment |