Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA.
National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA.
J Am Med Inform Assoc. 2018 Feb 1;25(2):187-191. doi: 10.1093/jamia/ocx057.
We sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) downtime periods by analyzing the narratives of patient safety event report data.
From a database of 80 381 event reports, 76 reports were identified as explicitly describing a safety event associated with an EHR downtime period. These reports were analyzed and categorized based on a developed code book to identify the clinical processes that were impacted by downtime. We also examined whether downtime procedures were in place and followed.
The reports were coded into categories related to their reported clinical process: Laboratory, Medication, Imaging, Registration, Patient Handoff, Documentation, History Viewing, Delay of Procedure, and General. A majority of reports (48.7%, n = 37) were associated with lab orders and results, followed by medication ordering and administration (14.5%, n = 11). Incidents commonly involved patient identification and communication of clinical information. A majority of reports (46%, n = 35) indicated that downtime procedures either were not followed or were not in place. Only 27.6% of incidents (n = 21) indicated that downtime procedures were successfully executed.
Patient safety report data offer a lens into EHR downtime-related safety hazards. Important areas of risk during EHR downtime periods were patient identification and communication of clinical information; these should be a focus of downtime procedure planning to reduce safety hazards.
EHR downtime events pose patient safety hazards, and we highlight critical areas for downtime procedure improvement.
通过分析患者安全事件报告数据的叙述，了解电子病历 (EHR) 停机期间中断的临床流程类型，如影像和医嘱下达。
从一个包含 80381 份事件报告的数据库中，确定了 76 份明确描述与 EHR 停机期间相关的安全事件的报告。这些报告根据开发的代码手册进行了分析和分类，以确定受停机影响的临床流程。我们还检查了停机程序是否已到位并得到遵循。
报告被编码为与其报告的临床流程相关的类别：实验室、医嘱、影像、登记、患者交接、文档、病史查看、手术延迟和一般。大多数报告（48.7%，n=37）与实验室医嘱和结果有关，其次是医嘱下达和管理（14.5%，n=11）。事件通常涉及患者身份识别和临床信息的沟通。大多数报告（46%，n=35）表明停机程序未得到遵循或未设置。只有 27.6%的事件（n=21）表明停机程序已成功执行。
患者安全报告数据提供了一个了解 EHR 停机相关安全风险的视角。EHR 停机期间的重要风险领域是患者身份识别和临床信息的沟通；这些应该是停机程序规划的重点，以减少安全风险。
EHR 停机事件会带来患者安全风险，我们强调停机程序改进的关键领域。
