Association of Display of Patient Photographs in the Electronic Health Record With Wrong-Patient Order Entry Errors

JAMA Netw Open. 2020 Nov 2;3(11):e2019652. doi: 10.1001/jamanetworkopen.2020.19652.


Importance: 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). Previous research shows that interruptive solutions, such as electronic patient verification forms or alerts, can reduce these types of errors but may be time-consuming and cause alert fatigue.

Objective: 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.

Design, setting, and participants: In this cohort study, data collected as part of care for patients visiting the ED of a large tertiary academic urban hospital in Boston, Massachusetts, between July 1, 2017, and June 31, 2019, were analyzed.

Exposures: In a quality improvement initiative, the ED staff encouraged patients to have their photographs taken by informing them of the intended safety impact.

Main outcomes and measures: The rate of WPOE errors (measured using the retract-and-reorder method) for orders placed when the patient's photograph was displayed in the banner of the EHR vs the rate for patients without a photograph displayed. The primary analysis focused on orders placed in the ED; a secondary analysis included orders placed in any care setting.

Results: A total of 2 558 746 orders were placed for 71 851 unique patients (mean [SD] age, 49.2 [19.1] years; 42 677 (59.4%) female; 55 109 (76.7%) non-Hispanic). The risk of WPOE errors was significantly lower when the patient's photograph was displayed in the EHR (odds ratio, 0.72; 95% CI, 0.57-0.89). After this risk was adjusted for potential confounders using multivariable logistic regression, the effect size remained essentially the same (odds ratio, 0.57; 95% CI, 0.52-0.61). Risk of error was significantly lower in patients with higher acuity levels and among patients whose race was documented as White.

Conclusions and relevance: This cohort study suggests that displaying patient photographs in the EHR provides decision support functionality for enhancing patient identification and reducing WPOE errors while being noninterruptive with minimal risk of alert fatigue. Successful implementation of such a program in an ED setting involves a modest financial investment and requires appropriate engagement of patients and staff.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Boston
  • Cohort Studies
  • Diagnostic Errors / prevention & control*
  • Diagnostic Errors / statistics & numerical data
  • Electronic Health Records / standards*
  • Electronic Health Records / statistics & numerical data*
  • Electronic Prescribing / standards*
  • Electronic Prescribing / statistics & numerical data
  • Female
  • Humans
  • Male
  • Medication Errors / prevention & control*
  • Medication Errors / statistics & numerical data
  • Middle Aged
  • Near Miss, Healthcare / standards*
  • Near Miss, Healthcare / statistics & numerical data
  • Odds Ratio
  • Photography*