56 Adding Patient Photos to the Electronic Health Record to Improve Patient Identification and Reduce Wrong Patient Order Errors

Abstract

The emergency department (ED) is a fast paced and pressured environment and providers sometimes have more than one patient record open at a time. Health care providers must be in the correct patient’s electronic health record (EHR) when performing any actions, especially computerized provider order entry otherwise orders may be placed for the wrong patient, and sometimes not caught. Wrong patient orders are estimated to occur in 2/1,000 orders and can lead to serious adverse events, including death. Other studies have reported that pop-up alerts containing the patient’s photo displayed before placing or signing orders can reduce the rate of wrong patient orders, but these alerts are highly interruptive and associated with alert fatigue. The goal of this project is to determine if displaying patient photos passively in the EHR header can reduce wrong patient orders in the ED. This project, piloted at a large urban academic medical center’s ED, required that we increase the number of patient photos in the EHR for ED patients and analyze the impact to the rate of wrong orders. We created a new standard of care and implemented a new workflow for ED registration staff. Using iPod touch devices, ED registration staff take photos of consenting patients either at the front desk when patients check-in, or at the end of the registration process. A report was created and used to identify the number of ED patients who have a photo in the EHR. An ED patient advisory committee was consulted to gain insight into tactics to increase patient awareness and participation of the new policy. A previously validated “Retract-and-Reorder”(RAR) measure was used to identify the number of orders that were ordered, cancelled, and re-ordered on another patient within a 10 minute time period in the ED – essentially the rate of “near misses.” We developed a RAR report and used this to identify the “wrong-patient retract-and-reorder” (WP-RAR) rate for orders placed for patients with and without photos in the ED for the analysis period July 1, 2017 through December 31, 2018. We compared the relative risk of the WP-RAR rate for ED patients with and without photos in their EHRusing the chi-squared statistic and Fisher’s exact test. The rate of ED patients with photos in the banner of their EHR record exceeded 50% at the time of the analysis. There were 1,210,876 ED orders placed during the 18 month analysis period; 996,223 (82%) without a photo and 213,643 (18%) with a photo. There were 312 total ED WP-RAR (near miss) events; 275 (88%) without photo and 37 (12%) with photo. The overall ED WP-RAR rate was 25.7 per 100,000 orders and was statistically significantly lower for patients who had photos: ED WP-RAR with Photos = 17.2/100,000 orders compared to ED WP-RAR without Photos = 27.6 /100,000 orders. Relative Risk = 0.625 (95% CI = 0.44 – 0.88, p = 0.0025). A passive display of patient photos in the EHR is associated with reduced rates of wrong patient orders and near misses in an ED setting. Since passive patient photo display is a common feature supported by EHR vendors, EDs should consider investing in photo capture hardware (smart devices, cables, and locks) and including photo capture in ED registration workflow as a way to improve patient safety in the ED.