Association between limiting the number of open records in a tele-critical care setting and retract-reorder errors

Chiedozie Udeh; Christina Canfield; Isaac Briskin; Aaron C Hamilton

doi:10.1093/jamia/ocab072

Association between limiting the number of open records in a tele-critical care setting and retract-reorder errors

J Am Med Inform Assoc. 2021 Jul 30;28(8):1791-1795. doi: 10.1093/jamia/ocab072.

Authors

Chiedozie Udeh¹, Christina Canfield², Isaac Briskin³, Aaron C Hamilton⁴

Affiliations

¹ Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
² Medical Operations, Cleveland Clinic, Cleveland, Ohio, USA.
³ Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁴ Department of Hospital Medicine, Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Abstract

Background: Wrong patient selection errors may be tracked by retract-reorder (RAR) events. The aim of this quality improvement study was to assess the impact of reducing the number of concurrently open electronic health records from 4 to 2 on RAR errors generated by a tele-critical care service.

Methods: The study encompassed 32 months before and 21 months after restriction. Chi-Square test of proportions and T statistical process control chart for rare events were used.

Results: There were 156 318 orders with 57 RAR errors (36.5/100 000 orders) before restriction, and 122 587 orders with 34 errors (27.7/100 000 orders) after. Rates were not statistically different (P = .20), but analysis was underpowered. When plotted on a T control chart, random variation was detected between RAR errors.

Conclusion: We found no significant difference in RAR errors in the tele-critical care setting after open record limitation. Other strategies should be studied to reduce wrong patient selection errors.

Keywords: information technology; medical errors; medical order entry systems; patient safety; telemedicine.

MeSH terms

Critical Care
Electronic Health Records*
Humans
Quality Improvement*