Evaluating the Impact of Patient Photographs for Preventing Wrong-Patient Errors

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

10426 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-16

Study Completion Date

2024-04-01

Brief Summary

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This is a multi-site, 4-arm randomized controlled trial to test the effectiveness of patient photographs displayed in electronic health record (EHR) systems to prevent wrong-patient order errors. The study will be conducted at several academic medical centers that utilize two different EHR systems. Because EHR systems have different functionality for displaying patient photographs, two different study designs will be employed. In Allscripts EHR, a 2-arm randomized trial will be conducted in which providers are randomized to view order verification alerts with versus without patient photographs when placing electronic orders. In Epic EHR, a 2x2 factorial trial will be conducted in which providers are randomized to one of four conditions: 1) no photograph; 2) photograph displayed in the banner only; 3) photograph displayed in a verification alert only; or 4) photograph displayed in the banner and verification alert. The main hypothesis of this study is that displaying patient photographs in the EHR will significantly reduce the frequency of wrong-patient order errors, providing health systems with the evidence needed to adopt this safety practice.

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Detailed Description

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Although Computerized provider order entry (CPOE) systems are associated with a reduction in medical errors, when orders are placed electronically certain types of errors, including placing orders on the wrong patient, may occur more frequently. The danger of wrong-patient electronic orders was highlighted by one hospital's report of over 5,000 wrong patient orders in 1 year. With the growing use of electronic health records (EHRs), an effective method to minimize wrong-patient orders is needed. One study showed that patient photographs displayed in EHR systems decreased wrong-patient orders from 12 to 3 per year after patient photographs were implemented. While encouraging, this study was limited due to its small sample size, compared outcomes of the intervention participants to outcomes of a comparison group similar in demographics but may have differed in ways that were not measured in the study (quasi-experimental design), and reliance on voluntary reporting of errors by providers, which is known to be unreliable and greatly underestimate the actual error rate. This research proposes to use an automated and reliable measure of wrong-patient errors instead of voluntary reporting will demonstrate that patient photographs can significantly prevent wrong-patient orders.

Conditions

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Medical Errors Electronic Medical Records

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Photo in Verification Alert

Patient photo displayed in a patient ID verification alert when placing electronic orders in the electronic health record.

Group Type ACTIVE_COMPARATOR

Photo in Verification Alert

Intervention Type BEHAVIORAL

Patient photograph displayed in a patient ID verification alert when placing electronic orders in the electronic health record.

Photo in Banner

Patient photo displayed in the banner (at the top of the screen).

Group Type ACTIVE_COMPARATOR

Photo in Banner

Intervention Type BEHAVIORAL

Patient photograph will be displayed in the banner at the top of the screen in the electronic health record.

Photo in Banner and Verification Alert

Patient photograph displayed in the banner (at the top of the screen) AND patient photo displayed in a verification alert when placing electronic orders.

Group Type ACTIVE_COMPARATOR

Photo in Banner and Verification Alert

Intervention Type BEHAVIORAL

Patient photograph will be displayed in the banner at the top of the screen in the electronic health record AND patient photograph displayed in a patient ID verification alert when placing electronic orders in the electronic health record.

No Photo

No patient photographs displayed in the electronic health record.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Photo in Verification Alert

Patient photograph displayed in a patient ID verification alert when placing electronic orders in the electronic health record.

Intervention Type BEHAVIORAL

Photo in Banner

Patient photograph will be displayed in the banner at the top of the screen in the electronic health record.

Intervention Type BEHAVIORAL

Photo in Banner and Verification Alert

Patient photograph will be displayed in the banner at the top of the screen in the electronic health record AND patient photograph displayed in a patient ID verification alert when placing electronic orders in the electronic health record.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* All patients for whom an order was placed in the study period.
* All providers with the authority to place electronic orders and who placed electronic orders during the study period.