A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission

Regenstrief Institute for Health Care, Indianapolis, Indiana 46202-2859, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 09/1997; 4(5):364-75. DOI: 10.1136/jamia.1997.0040364
Source: PubMed

ABSTRACT 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.

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Available from: J. Marc Overhage, Sep 29, 2015
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    • "An example can be found from medical informatics , where physicians often make mistakes of omitting certain tests or treatments. These errors were reduced by developing an automated reminder for certain treatments and tests based on medical practice guidelines [9]. "
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    • "Implementation of order sets and similar clinical decision support systems (CDSS) in an electronic medical record (EMR) with computerized physician order entry (CPOE) helps reinforce consistency among practitioners and support compliance with best-practice guidelines[ 1 ] [ 2 ]. While order sets and corollary orders can greatly benefit clinical practice, a top-down distribution model limits their benefit. "
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