Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Business School, Harvard University, Boston, Massachusetts, USA.
J Am Med Inform Assoc. 2020 Aug 1;27(8):1252-1258. doi: 10.1093/jamia/ocaa098.
The study sought to evaluate the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in both 2017 and 2018, along with their performance against fatal orders and nuisance orders.
We evaluated 1599 hospitals that took the test in both 2017 and 2018 by using their overall percentage scores on the test, along with the percentage of fatal orders appropriately alerted on, and the percentage of nuisance orders incorrectly alerted on.
Hospitals showed overall improvement; the mean score in 2017 was 58.1%, and this increased to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0% (P < .001), though there was almost no change in nuisance order performance (89.0% to 89.7%; P = .43). Hospitals alerting on one or more nuisance orders had a 3-percentage-point increase in their overall score.
Despite the improvement of overall scores in 2017 and 2018, there was little improvement in fatal order performance, suggesting that hospitals are not targeting the deadliest orders first. Nuisance order performance showed almost no improvement, and some hospitals may be achieving higher scores by overalerting, suggesting that the thresholds for which alerts are fired from are too low.
Although hospitals improved overall from 2017 to 2018, there is still important room for improvement for both fatal and nuisance orders. Hospitals that incorrectly alerted on one or more nuisance orders had slightly higher overall performance, suggesting that some hospitals may be achieving higher scores at the cost of overalerting, which has the potential to cause clinician burnout and even worsen safety.
本研究旨在评估 2017 年和 2018 年使用计算机化医嘱录入评估工具的医院的整体表现，以及它们在致命医嘱和干扰性医嘱方面的表现。
我们通过评估这两年参加测试的 1599 家医院在测试中的总体百分比得分，以及适当警报的致命医嘱的百分比和错误警报的干扰性医嘱的百分比，来评估他们的表现。
医院的整体表现有所提高；2017 年的平均得分为 58.1%，而 2018 年则提高到 66.2%。致命医嘱的表现从 78.8%略有提高到 83.0%（P < .001），而干扰性医嘱的表现几乎没有变化（89.0%至 89.7%；P = .43）。对一个或多个干扰性医嘱进行警报提示的医院，其总得分提高了 3 个百分点。
尽管 2017 年和 2018 年的总体得分有所提高，但致命医嘱的表现几乎没有改善，这表明医院并没有首先针对最致命的医嘱进行干预。干扰性医嘱的表现几乎没有改善，一些医院可能通过过度警报来获得更高的分数，这表明触发警报的阈值太低。
尽管医院在 2017 年至 2018 年期间整体表现有所提高，但在致命和干扰性医嘱方面仍有很大的改进空间。对一个或多个干扰性医嘱错误警报提示的医院，其整体表现略有提高，这表明一些医院可能以过度警报为代价获得更高的分数，这可能导致临床医生的疲惫甚至安全状况恶化。
