It’s a classic line: “Doctor, did you mean to order Geodon for room 12? They’re here for urinary issues.”
And, the rolling of eyes, the harried return to the electronic health record – to cancel an order, re-order on the correct patient, and return to the business at hand.
Unfortunately, the human checks in the system don’t always catch these wrong-patient errors, leading to potential serious harms. As such, this handful of folks decided to test an intervention intended to reduce wrong-patient orders: a built-in system delay. For every order, a confirmation screen is generated with contextual patient information. The innovation in this case, is the alert cannot be dismissed until a 2.5 second timer completes. The theory being, this extra, mandatory wait time will give the ordering clinician a chance to realize their error and cancel out.
Based on a before-and-after design, and observation of 3,457,342 electronic orders across 5 EDs, implementation of this confirmation screen reduced apparent wrong-patient orders from approximately 2 per 1,000 orders to 1.5 per 1,000. With an average of 30 order-entry sessions per 12-hour shift in these EDs, this patient verification alert had a measured average impact of a mere 2.1 minutes of time.
Which doesn’t sound like much – until it accumulates across all EDs and patient encounters, and, in just the 4 month study period, this system occupied 562 hours of extra time. This works out to 70 days of extra physician time in these five EDs. As Robert Wears then beautifully estimates in his editorial, if this alert were implemented nationwide, it would result in 900,000 additional hours of physician time per year – just staring numbly at an alert to verify the correct patient.
It is fairly clear this demonstration is a suboptimal solution to the problem. While this alert certainly reduces wrong-patient orders of a measurable magnitude, the number of adverse events avoided is much, much smaller. However, in the absence of an ideal solution, such alternatives as this tend to take root. As you imagine and experience the various alerts creeping into the system from every angle, it seems inevitably clear: we will ultimately spend our entire day just negotiating with the EHR, with zero time remaining for clinical care.
“Intercepting Wrong-Patient Orders in a Computerized Provider Order Entry System”
http://www.ncbi.nlm.nih.gov/pubmed/25534652
“‘Just a Few Seconds of Your Time.’ at Least 130 Million Times a Year”
http://www.ncbi.nlm.nih.gov/pubmed/25724623