{"id":17179,"date":"2019-05-17T04:55:31","date_gmt":"2019-05-16T20:55:31","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17179"},"modified":"2019-06-02T06:40:54","modified_gmt":"2019-06-01T22:40:54","slug":"jama%e6%9c%80%e6%96%b0%e5%8f%91%e8%a1%a8%ef%bc%9a%e9%99%90%e5%88%b6%e7%94%b5%e5%ad%90%e7%97%85%e5%8e%86%e8%ae%b0%e5%bd%95%e5%90%8c%e6%97%b6%e6%89%93%e5%bc%80%e8%ae%b0%e5%bd%95%e6%95%b0%e5%af%b9","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17179","title":{"rendered":"[JAMA\u6700\u65b0\u53d1\u8868]\uff1a\u9650\u5236\u7535\u5b50\u75c5\u5386\u8bb0\u5f55\u540c\u65f6\u6253\u5f00\u8bb0\u5f55\u6570\u5bf9\u9519\u8bef\u533b\u5631\u7684\u5f71\u54cd\uff1a\u4e00\u9879\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c"},"content":{"rendered":"\n

Original Investigation May 14, 2019<\/p>\n\n\n\n

Effect of Restriction of the Number of Concurrently Open Records in an Electronic Health Record on Wrong-Patient Order Errors: A Randomized Clinical Trial<\/h1>\n\n\n\n

Jason S. Adelman, Jo R. Applebaum, Clyde B. Schechter, et al<\/h3>\n\n\n\n

JAMA. <\/em>2019;321(18):1780-1787. doi:10.1001\/jama.2019.3698<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Importance<\/strong> \u80cc\u666f<\/h2>\n\n\n\n

Recommendations in the United States suggest limiting the number of patient records displayed in an electronic health record (EHR) to 1 at a time, although little evidence supports this recommendation.<\/p>\n\n\n\n

\u7f8e\u56fd\u7684\u63a8\u8350\u610f\u89c1\u5efa\u8bae\u5c06\u7535\u5b50\u75c5\u5386\u8bb0\u5f55(EHR)\u4e00\u6b21\u663e\u793a\u7684\u60a3\u8005\u8bb0\u5f55\u6570\u76ee\u9650\u5236\u4e3a1\uff0c\u5c3d\u7ba1\u4ec5\u6709\u5f88\u5c11\u7684\u8bc1\u636e\u652f\u6301\u8fd9\u4e00\u63a8\u8350\u610f\u89c1<\/p>\n\n\n\n

Objective<\/strong> \u76ee\u7684<\/h2>\n\n\n\n

To assess the risk of wrong-patient orders in an EHR configuration limiting clinicians to 1 record vs allowing up to 4 records opened concurrently.<\/p>\n\n\n\n

\u8bc4\u4f30EHR\u914d\u7f6e\u4e2d\u9650\u5236\u533b\u751f\u540c\u65f6\u6253\u5f00\u7684\u60a3\u8005\u8bb0\u5f55\u6570\u76ee\u4e3a1\u548c4\u65f6\u9519\u8bef\u533b\u5631\u7684\u98ce\u9669<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong> \u8bd5\u9a8c\u8bbe\u8ba1\uff0c\u573a\u666f\u548c\u7814\u7a76\u5bf9\u8c61<\/h2>\n\n\n\n

This randomized clinical trial included 3356 clinicians at a large health system in New York and was conducted from October 2015 to April 2017 in emergency department, inpatient, and outpatient settings.<\/p>\n\n\n\n

\u8fd9\u9879\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u4e8e2015\u5e7410\u6708\u81f32017\u5e744\u6708\uff0c\u5728\u7ebd\u7ea6\u5dde\u7684\u4e00\u5bb6\u5927\u578b\u533b\u7597\u4e2d\u5fc3\u7684\u6025\u8bca\u79d1\u3001\u4f4f\u9662\u90e8\u53ca\u95e8\u8bca\u90e8\u8fdb\u884c\uff0c3356\u540d\u4e34\u5e8a\u533b\u751f\u53c2\u52a0\u3002<\/p>\n\n\n\n

Interventions<\/strong> \u5e72\u9884\u63aa\u65bd<\/h2>\n\n\n\n

Clinicians were randomly assigned in a 1:1 ratio to an EHR configuration limiting to 1 patient record open at a time (restricted; n\u2009=\u20091669) or allowing up to 4 records open concurrently (unrestricted; n\u2009=\u20091687).<\/p>\n\n\n\n

\u4e34\u5e8a\u533b\u751f\u6309\u71671:1\u7684\u6bd4\u4f8b\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u4e3aEHR\u914d\u7f6e\u9650\u5236\u540c\u65f6\u6253\u5f001\u540d\u60a3\u8005\u8bb0\u5f55\uff08\u9650\u5236\u7ec4\uff1bn = 1669\uff09\u6216\u5141\u8bb8\u540c\u65f6\u6253\u5f004\u540d\u60a3\u8005\u8bb0\u5f55\uff08\u975e\u9650\u5236\u7ec4\uff1bn = 1687\uff09\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong> \u4e3b\u8981\u9884\u540e\u6307\u6807<\/h2>\n\n\n\n

The unit of analysis was the order session, a series of orders placed by a clinician for a single patient. The primary outcome was order sessions that included 1 or more wrong-patient orders identified by the Wrong-Patient Retract-and-Reorder measure (an electronic query that identifies orders placed for a patient, retracted, and then reordered shortly thereafter by the same clinician for a different patient).<\/p>\n\n\n\n

\u5206\u6790\u5355\u5143\u4e3a\u533b\u5631\u7ec4\uff0c\u5373\u533b\u751f\u4e3a\u4e00\u540d\u60a3\u8005\u5f00\u5177\u7684\u4e00\u7cfb\u5217\u533b\u5631\u3002\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a\u9519\u8bef\u533b\u5631\u64a4\u9500\u91cd\u5f00\u7cfb\u7edf\uff08\u53d1\u73b0\u533b\u751f\u4e3a\u67d0\u4f4d\u60a3\u8005\u5f00\u5177\u533b\u5631\uff0c\u968f\u540e\u64a4\u9500\uff0c\u7136\u540e\u5f88\u5feb\u4e3a\u53e6\u5916\u4e00\u540d\u60a3\u8005\u5f00\u5177\u540c\u6837\u533b\u5631\uff09\u53d1\u73b0\u7684\u5305\u62ec1\u4e2a\u6216\u4ee5\u4e0a\u9519\u8bef\u533b\u5631\u7684\u533b\u5631\u7ec4\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h2>\n\n\n\n

Among the 3356 clinicians who were randomized (mean [SD] age, 43.1 [12.5] years; mean [SD] experience at study site, 6.5 [6.0] years; 1894 females [56.4%]), all provided order data and were included in the analysis. The study included 12\u202f140\u202f298 orders, in 4\u202f486\u202f631 order sessions, placed for 543\u202f490 patients. There was no significant difference in wrong-patient order sessions per 100\u202f000 in the restricted vs unrestricted group, respectively, overall (90.7 vs 88.0; odds ratio [OR], 1.03 [95% CI, 0.90-1.20]; P<\/em>\u2009=\u2009.60) or in any setting (ED: 157.8 vs 161.3, OR, 1.00 [95% CI, 0.83-1.20], P<\/em>\u2009=\u2009.96; inpatient: 185.6 vs 185.1, OR, 0.99 [95% CI, 0.89-1.11]; P<\/em>\u2009=\u2009.86; or outpatient: 7.9 vs 8.2, OR, 0.94 [95% CI, 0.70-1.28], P<\/em>\u2009=\u2009.71). The effect did not differ among settings (P<\/em> for interaction\u2009=\u2009.99). In the unrestricted group overall, 66.2% of the order sessions were completed with 1 record open, including 34.5% of ED, 53.7% of inpatient, and 83.4% of outpatient order sessions.<\/p>\n\n\n\n

\u63a5\u53d7\u968f\u673a\u5206\u7ec4\u76843356\u540d\u4e34\u5e8a\u533b\u751f\uff08\u5e73\u5747[SD]\u5e74\u9f84\uff0c43.1 [12.5]\u5c81\uff1b\u5728\u7814\u7a76\u4e2d\u5fc3\u5e73\u5747\u5de5\u4f5c\u5e74\u9650\uff0c6.5 [6.0]\u5c81\uff1b1894\u540d\u5973\u6027[56.4%]\uff09\u5747\u63d0\u4f9b\u4e86\u533b\u5631\u6570\u636e\uff0c\u5e76\u7eb3\u5165\u5206\u6790\u3002\u7814\u7a76\u7eb3\u5165\u5bf9543490\u540d\u60a3\u8005\u5f00\u5177\u76844486631\u4e2a\u533b\u5631\u7ec4\uff0c\u5171\u5305\u62ec12140298\u4e2a\u533b\u5631\u3002\u9650\u5236\u7ec4\u548c\u975e\u9650\u5236\u7ec4\u6bcf100000\u4e2a\u533b\u5631\u7ec4\u4e2d\u9519\u8bef\u533b\u5631\u5e76\u65e0\u663e\u8457\u5dee\u5f02\uff0890.7 vs 88.0; \u6bd4\u6570\u6bd4 [OR], 1.03 [95% CI, 0.90-1.20]; P<\/em>\u2009=\u2009.60\uff09\uff0c \u5728\u4e0d\u540c\u573a\u6240\u4e2d\u9519\u8bef\u533b\u5631\u4e5f\u65e0\u663e\u8457\u62c6\uff08ED: 157.8 vs 161.3, OR, 1.00 [95% CI, 0.83-1.20], P<\/em>\u2009=\u2009.96; \u4f4f\u9662\u90e8: 185.6 vs 185.1, OR, 0.99 [95% CI, 0.89-1.11]; P<\/em>\u2009=\u2009.86; \u6216\u95e8\u8bca\u90e8: 7.9 vs 8.2, OR, 0.94 [95% CI, 0.70-1.28], P<\/em>\u2009=\u2009.71\uff09\u3002\u4e0a\u8ff0\u6548\u679c\u5728\u4e0d\u540c\u573a\u6240\u4e2d\u5e76\u65e0\u5dee\u5f02\uff08\u4ea4\u4e92\u4f5c\u7528P<\/em>\u2009=\u2009.99\uff09\u3002\u5728\u975e\u9650\u5236\u7ec4\uff0c66.2%\u7684\u533b\u5631\u7ec4\u5728\u6253\u5f001\u540d\u60a3\u8005\u8bb0\u5f55\u7684\u60c5\u51b5\u4e0b\u5f00\u5177\uff0c\u5305\u62ecED 34.5%\uff0c\u4f4f\u9662\u90e853.7%\uff0c\u53ca\u95e8\u8bca\u90e883.4%\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong> \u7ed3\u8bba\u4e0e\u610f\u4e49<\/h2>\n\n\n\n

A strategy that limited clinicians to 1 EHR patient record open compared with a strategy that allowed up to 4 records open concurrently did not reduce the proportion of wrong-patient order errors. However, clinicians in the unrestricted group placed most orders with a single record open, limiting the power of the study to determine whether reducing the number of records open when placing orders reduces the risk of wrong-patient order errors.<\/p>\n\n\n\n

\u4e0e\u5141\u8bb8\u540c\u65f6\u6253\u5f004\u540d\u60a3\u8005\u8bb0\u5f55\u7684\u7b56\u7565\u76f8\u6bd4\uff0c\u9650\u5236\u4e34\u5e8a\u533b\u751f\u4ec5\u80fd\u6253\u5f001\u540dEHR\u60a3\u8005\u8bb0\u5f55\u7684\u7b56\u7565\u4e0d\u80fd\u51cf\u5c11\u9519\u8bef\u533b\u5631\u6bd4\u4f8b\u3002\u7136\u800c\uff0c\u975e\u9650\u5236\u7ec4\u7684\u4e34\u5e8a\u533b\u751f\u5728\u6253\u5f00\u4e00\u540d\u60a3\u8005\u8bb0\u5f55\u7684\u60c5\u51b5\u4e0b\u5f00\u5177\u4e86\u5f88\u591a\u533b\u5631\uff0c\u4ece\u800c\u5f71\u54cd\u4e86\u672c\u7814\u7a76\u7684\u6548\u529b\uff0c\u5373\u786e\u5b9a\u51cf\u5c11\u5f00\u5177\u533b\u5631\u65f6\u5f00\u653e\u8bb0\u5f55\u6570\u80fd\u5426\u51cf\u5c11\u9519\u8bef\u533b\u5631\u7684\u98ce\u9669\u3002<\/p>\n\n\n\n

Trial Registration<\/strong> \u8bd5\u9a8c\u6ce8\u518c<\/h2>\n\n\n\n

clinicaltrials.gov Identifier: NCT02876588<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation May 14, 2019 Effe […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17179"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17179"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17179\/revisions"}],"predecessor-version":[{"id":17188,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17179\/revisions\/17188"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17179"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17179"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17179"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}