Tejal Gandhi

..Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause. We identify types and causes of missed or delayed diagnoses in the ED...

..Based on these findings, we have made specific recommendations for increasing the specificity of alerting and thereby improving the clinical utility of the drug allergy alerting system...

..Awareness of the most common types of breakdowns and factors could help efforts to identify and prioritize strategies to prevent diagnostic errors...

..We developed a computerized ADE measurement process and used it to detect ADEs from electronic health records and then categorized them according to type, preventability, and severity...

..This team should also work with individual departments and pre-existing quality structures to drive changes to the systems of care to enable health care to become as safe as possible...

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..However, few data are available on adverse drug events among outpatients. We conducted a study to determine the rates, types, severity, and preventability of such events among outpatients and to identify preventive strategies...

..Medication errors are common among inpatients and many are preventable with computerized prescribing. Relatively little is known about outpatient prescribing errors or the impact of computerized prescribing in this setting...

..Little is known concerning the safety of the outpatient chemotherapy process. In the current study, the authors sought to identify medication error and potential adverse drug event (ADE) rates in the outpatient chemotherapy setting...

..Developing the information-tracking database has made providing feedback easier and more reliable but significant effort is required to keep the database current...

..These data suggest that it is possible to design computerized prescribing decision support with high rates of alert recommendation acceptance by clinicians...

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..Nonetheless, consensus about some issues has been reached, in particular because of a well delineated patient safety structure. We believe the net result will be substantial improvement in patient safety...

..CONCLUSION: An integrated electronic reminder system resulted in variable improvement in care for diabetes and CAD. These improvements were often limited and quality gaps persist...

..The objective of this study was to assess the impact of physicians' use of a test results management tool embedded in an electronic health record on patient satisfaction with test result communication...

..Staff resistance was addressed through clear communication, identifying champions, emphasizing new information provided by the system, and facilitating collaboration...

..Pharmacist-based interventions may be effective in promoting the safe and effective use of medications, especially among high-risk patients such as those with low health literacy...

..Communication breakdown and information loss, as well as increased workload and competing tasks, pose the greatest threats to patient safety in the operating room...

..Failure to reconcile medications across transitions in care is an important source of potential harm to patients. Little is known about the predictors of unintentional medication discrepancies and how, when, and where they occur...

..Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care...

..To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR)...

..013), helpful to patients in visit preparation (66% vs 20%; p=0.082), and would recommend them to colleagues (78% vs 22%; p=0.0143). eJournal integration into practice warrants further study...

..Few computerized systems have been deployed at care transitions to address this problem. We describe an attempt to implement a computerized application to help inpatient physicians manage these test results...

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..The purpose of this study was to assess the costs and benefits and determine the return on investment at the institutional level for implementing a pharmacy bar code system...

..Further research will determine the long term impact and sustainability of this approach...

..We sought to determine if rates of provider compliance with DDI alerts in the inpatient setting differed when a tiered presentation was implemented...

..Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians...

..Further analyses will determine the effects of this module on important medication-related outcomes and identify further enhancements needed to improve on this approach...

..Most users agreed that medication reconciliation improves patient care but requested tighter integration of the different stages of the medication reconciliation process. Further training may be helpful in improving user efficiency...

..We evaluated the impact of electronic reminders delivered to primary care physicians on rates of appropriate routine medication laboratory monitoring...

..This lost opportunity to share information about readmitted patients may be detrimental to quality of care and resident education...

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..Several characteristics of electronic medication records are strongly associated with their validity. These findings could be incorporated in the design of CIS software to alert providers to medication records less likely to be accurate...

..We sought to measure the impact of an information technology-based medication reconciliation intervention on medication discrepancies with potential for harm (potential adverse drug events [PADEs])...

..Many dispensing errors made in hospital pharmacies can harm patients. Some hospitals are investing in bar code technology to reduce these errors, but data about its efficacy are limited...

..To identify the communication factors that are significantly associated with appropriate short-term follow-up of abnormal mammograms...

..Therefore, we sought to identify problems in current test result management systems and possible ways to improve these systems...

..Patients' knowledge of the indications of their prescription medications was studied and those medications that were most likely to be taken without patients understanding the correct indication were identified...

..The diagnosis and treatment of patients at risk of fragility fractures is uncommon. We examined the patient, physician, and practice characteristics associated with adherence to local osteoporosis guidelines...

..We also discuss its underlying architectural design, which revolves around a clinical event monitor and a rules engine, and the methodological challenges encountered in designing this application...

..Few data are available on the epidemiology of test results pending at discharge or on physician awareness of these results...

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..COLLECTING DATA ON WALKROUNDS: Data were obtained from interviews with patient safety personnel, WalkRounds scribes, and senior leaders...

..We sought to examine associations among patients' satisfaction survey ratings of physicians' performance and complaints from patients, risk management episodes, and rates of malpractice lawsuits...

..Implications of their findings are discussed...

..Executives are surveyed quarterly about actions they have taken as a direct result of WalkRounds and are asked what they have learned from the rounds...

..We also assessed the potential benefits of proved effective ADE prevention strategies on ADE claims prevention...

..A study was conducted at an academic tertiary care hospital to characterize the incidence and severity of medication dispensing errors in a hospital pharmacy...

..Clinician perceptions of a newly implemented electronic health record play an important role in its success or failure...

..CONCLUSIONS: Report cards that emphasize only one domain of quality or use limited data collection methods may provide incomplete or inconsistent information to health care consumers about the overall quality of an outpatient clinic...

..5; 95% CI: 1.3-8.9). CONCLUSIONS: Although further validation is necessary, these risk factors should help doctors identify patients with elevated risk for adverse drug events because of ACE inhibitors...

..The goal of this report is to discuss these lessons learned in the interest of informing the efforts of others working to make the practice of evidence-based medicine a reality...

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..Future work in this area will need to prospectively study the processes and factors that impact patient safety and vulnerability in the operating room...

..Process of care failures may contribute to diagnostic errors in breast cancer care...

..In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation--claims that lack evidence of injury, substandard care, or both--is common and costly...

..Nearly half of all medical visits are to specialist physicians, yet little is known about patients' outpatient experiences with specialists or how patients' characteristics and experiences are related to trust in specialist physicians...

..Our objectives were to determine how frequently clinicians prescribe drugs in violation of black box warnings for these issues and to determine how frequently such prescribing results in harm...

..To describe the incidence of adverse drug events (ADEs), preventable ADEs, and ameliorable ADEs occurring after hospital discharge and their associated risk factors...

..70 US dollars to detect an ADE and tiered approach cost only $42.40. CONCLUSION: Tiered review of ADEs and MEs by personnel with increasing clinical capability is more cost-efficient than pharmacist review...

..The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers...

..CONCLUSION: Adverse events occurred frequently in the peridischarge period, and many could potentially have been prevented or ameliorated with simple strategies...

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..The applicant believes that this study will advance the national patient safety agenda and significantly impact the way medication is delivered by hospitals in the future. ..

..Given the diversity of practices, these findings will be generalizable to other organizations and will speed the adoption of these systems. ..