A Comparison of One- and Four-Open-Chart Access: No Change in Computerized Provider Order Entry Error Rates

Area of Science:

• Health Informatics
• Medical Error Analysis
• Clinical Workflow Optimization

Background:

• Computerized provider order entry (CPOE) systems are crucial for medication safety.
• The impact of simultaneous chart access on CPOE error rates is not well understood.
• Rapid changes in system access can affect provider performance and patient safety.

Purpose of the Study:

• To evaluate the effect of restricting access from four to one chart on CPOE error rates.
• To compare error rates across different provider specialties after access restriction.

Main Methods:

• An interrupted time series analysis was conducted on emergency medicine, hospitalist, and maternal child health providers.
• Error rates were compared across four phases: baseline (4 charts), restricted (1 chart), return to 4 charts, and follow-up (4 charts).
• Statistical analysis included Wilcoxon signed-rank and Kruskal-Wallis tests.

Main Results:

• No statistically significant differences in CPOE error rates were observed across the four phases overall or within specialties.
• Significant differences in CPOE error rates were found between the three specialties in each phase.
• Specialty-specific error rates varied significantly, indicating distinct workflow or practice patterns.

Conclusions:

• Limiting providers to one chart simultaneously does not increase CPOE error rates.
• Inter-specialty differences in error rates highlight the need to investigate standardized order sets, charting practices, and workflow variations.
• Further research is warranted to optimize CPOE use and minimize errors based on specialty-specific needs.