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Journal of the American Medical Informatics Association : JAMIA logoLink to Journal of the American Medical Informatics Association : JAMIA
. 1994 Sep-Oct;1(5):404–411. doi: 10.1136/jamia.1994.95153428

Potential identifiability and preventability of adverse events using information systems.

D W Bates 1, A C O'Neil 1, D Boyle 1, J Teich 1, G M Chertow 1, A L Komaroff 1, T A Brennan 1
PMCID: PMC116222  PMID: 7850564

Abstract

STUDY OBJECTIVE: To evaluate the potential ability of computerized information systems (ISs) to identify and prevent adverse events in medical patients. DESIGN: Clinical descriptions of all 133 adverse events identified through chart review for a cohort of 3,138 medical patients were evaluated by two reviewers. MEASUREMENTS: For each adverse event, three hierarchical levels of IS sophistication were considered: Level 1--demographics, results for all diagnostic tests, and current medications would be available on-line; Level 2--all orders would be entered on-line by physicians; and Level 3--additional clinical data, such as automated problem lists, would be available on-line. Potential for event identification and potential for event prevention were scored by each reviewer according to two distinct sets of event monitors. RESULTS: Of all the adverse events, 53% were judged identifiable using Level 1 information, 58% were judged identifiable using Level 2 information, and 89% were judged identifiable using Level 3 information. The highest-yield event monitors for identifying adverse events were "panic" laboratory results, unexpected transfer to an intensive care unit, and hospital-incurred trauma. With information from Levels 1, 2, and 3, 5%, 13%, and 23% of the adverse events, respectively, were judged preventable. For preventing these adverse events, guided-dose algorithms, drug-laboratory checks, and drug-patient characteristic checks held the most potential.

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Selected References

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