Automated Lab Test Follow-up to Reduce Medical Errors

自动化实验室测试跟进以减少医疗错误

• 批准号: 6580921
• 负责人: DAVID S GREENES
• 金额: $ 5.72万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2004-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6580921
• 关键词: automated data processing; behavioral /social science research tag; clinical research; computer assisted diagnosis; computer program /software; computer system design /evaluation; cost effectiveness; diagnosis quality /standard; diagnostic tests; emergency health services; health care cost /financing; health care facility information system; health care service evaluation; health services research tag; human data; medical records; outcomes research; outpatient care; patient safety /medical error; telecommunications

DESCRIPTION (provided by applicant): Medical errors occur frequently when clinicians fail to respond to abnormal laboratory test results. This problem plays an especially important role in emergency departments, and other ambulatory settings because in many cases patients have been discharged by the time test results become available. An automated system to ensure follow-up for late-arriving test results may decrease rates of this type of medical error. This project will evaluate the effectiveness of a computerized system called the Automated Late-Arriving Results Monitoring System (ALARMS) in an emergency department. ALARMS gathers data from the hospital information system to generate a list of all late-arriving abnormal laboratory results. ALARMS prompts the user to respond to each result and then generates a note documenting the response, which becomes part of the medical record. The study hypothesis is that introduction of ALARMS will significantly improve rates of follow-up for late-arriving abnormal laboratory results. In the first phase, this project will evaluate the accuracy of ALARMS for identifying all late-arriving abnormal laboratory results, as compared to a manual review by researchers as the criterion standard. In the second phase, the emergency department's current rate of appropriate follow-up for late-arriving test results will be evaluated by running ALARMS in the background, with its output not yet available to clinicians. For each result identified by ALARMS, researchers will contact the patient individually to determine whether notification regarding the test result has occurred. In the third phase, ALARMS will be introduced for clinical use. Again, for each result identified by ALARMS, researchers will contact the patient to determine whether notification has occurred. The principal outcome measures will be the rate at which notification have occurred, comparing rates of medical errors (in the form of inadequate notification) before and after clinical implementation of the ALARMS system. As a secondary measure, rates of adverse events attributed to these errors will be measured as well. Finally, in the fourth phase of the study, some costs of using ALARMS, specifically, the time spent by clinicians addressing lab results that do not require follow-up, will be measured.

描述（由申请人提供）：当临床医生无法对异常的实验室测试结果做出反应时，医疗错误经常发生。 这个问题在急诊室和其他门诊环境中起着特别重要的作用，因为在许多情况下，患者已被时间测试结果释放。 一个自动化系统以确保对晚期测试结果的随访可能会降低此类医疗错误的率。 该项目将评估急诊室中称为自动化后置结果监控系统（警报）的计算机系统的有效性。 警报收集来自医院信息系统的数据，以生成所有晚期异常实验室结果的列表。警报提示用户对每个结果响应，然后生成一个记录响应的注释，这成为病历的一部分。 研究假设是，引入警报将显着提高晚期异常实验室结果的随访率。 在第一阶段，与研究人员作为标准标准相比，该项目将评估警报的准确性，以识别所有迟到的异常实验室结果。 在第二阶段，将通过在后台运行警报来评估急诊科当前的适当随访率，其产量尚未提供给临床医生。 对于由警报确定的每个结果，研究人员将单独与患者联系，以确定是否发生了有关测试结果的通知。 在第三阶段，将引入警报供临床使用。 同样，对于警报确定的每个结果，研究人员将与患者联系以确定是否发生了通知。 主要结果指标将是发生通知的速率，比较了警报系统临床实施之前和之后的医疗错误率（以通知不足的形式）。 作为次要措施，也将测量归因于这些错误的不良事件的速率。 最后，在研究的第四阶段，将测量使用警报的一些成本，特别是，将测量不需要随访的实验室结果所花费的时间。