Order errors not reduced with limiting number of open records


Background: An estimated 600,000 patients in U.S. hospitals had an order placed in their record that was meant for another patient in 2016. The Office of the National Coordinator for Health Information Technology and the Joint Commission recommend that EHRs limit the number of open records to one at a time based on expert opinion only. There is wide variation in the number of open records allowed among EHRs across the United States currently.

Study design: Randomized clinical trial.

Setting: Large health system in New York.

Synopsis: There were 3,356 clinicians (inpatient, outpatient, ED) randomized in a 1:1 ratio into either a restricted group (one open record at a time) or an unrestricted group (up to four open records at a time). In this study, 12,140,298 orders, in 4,486,631 order sessions, were analyzed with the Wrong-Patient Retract-and-Reorder (RAR) measure to identify wrong-patient orders. The proportion of wrong-patient order sessions were 90.7 vs. 88.0 per 100,000 order sessions for the restricted versus unrestricted groups (odds ratio, 1.03; 95% confidence interval, 0.90-1.20). There were no statistically significant differences in wrong-patient order sessions between the restricted and unrestricted groups in any clinical setting examined (inpatient, outpatient, ED).

Despite the ability to have up to four open records at one time in the unrestricted group, 66% of the order sessions were completed with only one record open in that group. This limited the power of the study to detect a difference in risk of order errors between the restricted and unrestricted groups.

Bottom line: Limiting clinicians to only one open record did not reduce the proportion of wrong-patient orders, compared with allowing up to four open records concurrently.

Citation: Adelman JS et al. Effect of restriction of the number of concurrently open records in an electronic health record on wrong-patient order errors: A randomized clinical trial. JAMA. 2019;32(18):1780-7.

Dr. Field is a hospitalist at Ochsner Health System, New Orleans.

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