A randomized trial of "corollary orders" to prevent errors of omission
Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/ameliorate the effects of other tests or treatments. The authors hypothesized that automated, guideline-based reminders to physicians, provided as they wrote orders, could...
Saved in:
Published in | Journal of the American Medical Informatics Association : JAMIA Vol. 4; no. 5; pp. 364 - 375 |
---|---|
Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
England
American Medical Informatics Association
01.09.1997
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/ameliorate the effects of other tests or treatments. The authors hypothesized that automated, guideline-based reminders to physicians, provided as they wrote orders, could reduce these omissions.
The study was performed on the inpatient general medicine ward of a public teaching hospital. Faculty and housestaff from the Indiana University School of Medicine, who used computer workstations to write orders, were randomized to intervention and control groups. As intervention physicians wrote orders for 1 of 87 selected tests or treatments, the computer suggested corollary orders needed to detect or ameliorate adverse reactions to the trigger orders. The physicians could accept or reject these suggestions.
During the 6-month trial, reminders about corollary orders were presented to 48 intervention physicians and withheld from 41 control physicians. Intervention physicians ordered the suggested corollary orders in 46.3% of instances when they received a reminder, compared with 21.9% compliance by control physicians (p < 0.0001). Physicians discriminated in their acceptance of suggested orders, readily accepting some while rejecting others. There were one third fewer interventions initiated by pharmacists with physicians in the intervention than control groups.
This study demonstrates that physician workstations, linked to a comprehensive electronic medical record, can be an efficient means for decreasing errors of omissions and improving adherence to practice guidelines. |
---|---|
Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23 Correspondence and reprints: Clement J. McDonald, MD, Regenstrief Institute for Health Care, 1001 West Tenth Street, RHC- 5th floor, Indianapolis, Indiana 46202-2859. E-mail: Clem@regen.rg.iupui.edu Financial support provided by Agency for Health Care Policy and Research, grants HS 05626 and HS 07719, National Library of Medicine, contract NO1-LM-3-3410. |
ISSN: | 1067-5027 1527-974X |
DOI: | 10.1136/jamia.1997.0040364 |