Recognition of Patient Selection Errors in a Simulated Computerized Provider Order Entry System

Abstract

Objective: To investigate whether the manipulation of a computerized provider order entry (CPOE) interface design will change provider recognition and correction of patient selection errors. Materials and Methods: Forty-six emergency medicine providers were randomly assigned to three groups (standard design, bolded patient identifiers, and contextual information) using a between-subjects design. Each participant navigated through 3 scenarios, including one with a forced patient selection error. The primary outcome was recognition and correction of the error. Secondary measures were the correction interval (time from introduction to correction) and the step in the ordering process at which recognition occurred. Results: We found an overall 24% error recognition rate. The error recognition rate and correction interval were both non-significant between groups. 82% of error recognitions occurred during the data entry (brief history, indication, room location) phase of ordering (p=0.03). Discussion: In this study 76% of providers did not recognize the occurrence of a patient selection error, with no significant impact from the addition of contextual information. This result suggests that providers do not routinely confirm patient identity after patient selection from the menu. However, when recognized, recovery took place significantly more often in the data entry phase which suggests this is where efforts should be focused. Conclusion: Medical providers do not routinely confirm patient identity after patient selection. Further study is needed to determine the most effective intervention to reduce the wrong patient selection order hazard, including the role of provider input in CPOE systems.