Study: emergency department information systems pose potential threats to patient safety and quality of care

Study: emergency department information systems pose potential threats to patient safety and quality of care

Heather L. Farley, M.D., FACEP
Heather L. Farley, M.D., FACEP

Some standard information systems in use in many of the nation’s hospital emergency departments present potential — but preventable — threats to patient safety and quality of care, Christiana Care researchers report this month in the Annals of Emergency Medicine.

Communication failure, poor data display, wrong order/wrong patient errors and alert fatigue are common pitfalls of these systems, which are designed to store and leverage electronic health records, according to lead author Heather L. Farley, M.D., FACEP, of the Christiana Care Health System’s Department of Emergency Medicine. However, they can be mitigated or avoided altogether by following established best practices in emergency department safety and performance improvement, the researchers conclude.

“The rush to capitalize on the huge federal investment of $30 billion for the adoption of electronic medical records led to some unfortunate consequences, particularly in the unique emergency department environment,” said Dr. Farley, who also serves as medical director at Christiana Care’s newly-opened Middletown Emergency Department. “Some of those consequences are related to product design, while others are due to user behavior. However, when these systems are designed and used in the right way, they can improve the coordination and quality of care and protect patients from unintended harm.”

Dr. Farley and colleagues present seven recommendations for addressing emergency department information system issues:

  • Appointing an emergency department “clinician champion” to maintain and lead performance improvement.
  • Creating a multidisciplinary emergency department information systems performance-improvement group.
  • Establishing an ongoing review process to monitor ongoing patient-safety issues within the emergency department information system.
  • Responding in a timely manner to emergency department information systems-related patient-safety concerns raised by the review process.
  • Publicly disseminating the lessons learned from performance-improvement efforts.
  • Distributing in a timely manner product updates from the emergency department information systems vendors to all users.
  • Removing of “hold harmless” and “learned intermediary” clauses from all vendor software contracts so they share responsibility for patient safety.

Emergency department information systems have been the focus of recent federal legislation, most notably the Health Information Technology for Economic and Clinical Health Act and the Affordable Care Act. Dr. Farley says the research team’s recommendations should be paired with those issued by the Institute of Medicine in its 2011 report “Health IT and Patient Safety: Building Safer Systems for Better Care.”

“The irreversible drive toward emergency department information systems implementation should be accompanied by a constant focus on improvement and hazard prevention,” Dr. Farley said. “Our paper and the Institute of Medicine paper create a framework for doing just that.”

Co-authors on the study include Kevin M. Baumlin, M.D.; Azita G. Hamedani, M.D., MPH; Dickson S. Cheung, M.D., MBA; Michael R. Edwards, M.D.; Drew C. Fuller, M.D., MPH; Nicholas Genes, M.D., PhD; Richard T. Griffey, M.D., MPH; John J. Kelly, DO; James C. McClay, MS, M.D.; Jeff Nielson, M.D., MS; Michael P. Phelan, M.D.; Jason S. Shapiro, M.D.; Suzanne Stone-Griffith, RN, MSN; Jesse M. Pines, M.D., MBA.

The study was funded in part by a grant from the American College of Emergency Physicians.