A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission

J. Marc Overhage, William M. Tierney, Xiao Hua Zhou, Clement J. McDonald

Research output: Contribution to journalArticle

251 Citations (Scopus)

Abstract

Objective: Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/ameliorate the effects of other tests or treatments. The authors hypothesized that automated, guideline-based reminders to physicians, provided as they wrote orders, could reduce these omissions. Design: The study was performed on the inpatient general medicine ward of a public teaching hospital. Faculty and housestaff from the Indiana University School of Medicine, who used computer workstations to write orders, were randomized to intervention and control groups. As intervention physicians wrote orders for 1 of 87 selected tests or treatments, the computer suggested corollary orders needed to detect or ameliorate adverse reactions to the trigger orders. The physicians could accept or reject these suggestions. Results: During the 6-month trial, reminders about corollary orders were presented to 48 intervention physicians and withheld from 41 control physicians. Intervention physicians ordered the suggested corollary orders in 46.3% of instances when they received a reminder, compared with 21.9% compliance by control physicians (p < 0.0001). Physicians discriminated in their acceptance of suggested orders, readily accepting some while rejecting others. There were one third fewer interventions initiated by pharmacists with physicians in the intervention than control groups. Conclusion: This study demonstrates that physician workstations, linked to a comprehensive electronic medical record, can be an efficient means for decreasing errors of omissions and improving adherence to practice guidelines.

Original languageEnglish
Pages (from-to)364-375
Number of pages12
JournalJournal of the American Medical Informatics Association
Volume4
Issue number5
StatePublished - Sep 1997

Fingerprint

Physicians
Medicine
Patients' Rooms
Control Groups
Electronic Health Records
Public Hospitals
Practice Guidelines
Pharmacists
Teaching Hospitals
Compliance
Inpatients
Therapeutics
Guidelines

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Overhage, J. M., Tierney, W. M., Zhou, X. H., & McDonald, C. J. (1997). A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission. Journal of the American Medical Informatics Association, 4(5), 364-375.

A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission. / Overhage, J. Marc; Tierney, William M.; Zhou, Xiao Hua; McDonald, Clement J.

In: Journal of the American Medical Informatics Association, Vol. 4, No. 5, 09.1997, p. 364-375.

Research output: Contribution to journalArticle

Overhage, JM, Tierney, WM, Zhou, XH & McDonald, CJ 1997, 'A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission', Journal of the American Medical Informatics Association, vol. 4, no. 5, pp. 364-375.
Overhage, J. Marc ; Tierney, William M. ; Zhou, Xiao Hua ; McDonald, Clement J. / A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission. In: Journal of the American Medical Informatics Association. 1997 ; Vol. 4, No. 5. pp. 364-375.
@article{4e1b4fd753664140a77a3de7b4ff5e0f,
title = "A Randomized Trial of {"}Corollary Orders{"} to Prevent Errors of Omission",
abstract = "Objective: Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/ameliorate the effects of other tests or treatments. The authors hypothesized that automated, guideline-based reminders to physicians, provided as they wrote orders, could reduce these omissions. Design: The study was performed on the inpatient general medicine ward of a public teaching hospital. Faculty and housestaff from the Indiana University School of Medicine, who used computer workstations to write orders, were randomized to intervention and control groups. As intervention physicians wrote orders for 1 of 87 selected tests or treatments, the computer suggested corollary orders needed to detect or ameliorate adverse reactions to the trigger orders. The physicians could accept or reject these suggestions. Results: During the 6-month trial, reminders about corollary orders were presented to 48 intervention physicians and withheld from 41 control physicians. Intervention physicians ordered the suggested corollary orders in 46.3{\%} of instances when they received a reminder, compared with 21.9{\%} compliance by control physicians (p < 0.0001). Physicians discriminated in their acceptance of suggested orders, readily accepting some while rejecting others. There were one third fewer interventions initiated by pharmacists with physicians in the intervention than control groups. Conclusion: This study demonstrates that physician workstations, linked to a comprehensive electronic medical record, can be an efficient means for decreasing errors of omissions and improving adherence to practice guidelines.",
author = "Overhage, {J. Marc} and Tierney, {William M.} and Zhou, {Xiao Hua} and McDonald, {Clement J.}",
year = "1997",
month = "9",
language = "English",
volume = "4",
pages = "364--375",
journal = "Journal of the American Medical Informatics Association : JAMIA",
issn = "1067-5027",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission

AU - Overhage, J. Marc

AU - Tierney, William M.

AU - Zhou, Xiao Hua

AU - McDonald, Clement J.

PY - 1997/9

Y1 - 1997/9

N2 - Objective: Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/ameliorate the effects of other tests or treatments. The authors hypothesized that automated, guideline-based reminders to physicians, provided as they wrote orders, could reduce these omissions. Design: The study was performed on the inpatient general medicine ward of a public teaching hospital. Faculty and housestaff from the Indiana University School of Medicine, who used computer workstations to write orders, were randomized to intervention and control groups. As intervention physicians wrote orders for 1 of 87 selected tests or treatments, the computer suggested corollary orders needed to detect or ameliorate adverse reactions to the trigger orders. The physicians could accept or reject these suggestions. Results: During the 6-month trial, reminders about corollary orders were presented to 48 intervention physicians and withheld from 41 control physicians. Intervention physicians ordered the suggested corollary orders in 46.3% of instances when they received a reminder, compared with 21.9% compliance by control physicians (p < 0.0001). Physicians discriminated in their acceptance of suggested orders, readily accepting some while rejecting others. There were one third fewer interventions initiated by pharmacists with physicians in the intervention than control groups. Conclusion: This study demonstrates that physician workstations, linked to a comprehensive electronic medical record, can be an efficient means for decreasing errors of omissions and improving adherence to practice guidelines.

AB - Objective: Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/ameliorate the effects of other tests or treatments. The authors hypothesized that automated, guideline-based reminders to physicians, provided as they wrote orders, could reduce these omissions. Design: The study was performed on the inpatient general medicine ward of a public teaching hospital. Faculty and housestaff from the Indiana University School of Medicine, who used computer workstations to write orders, were randomized to intervention and control groups. As intervention physicians wrote orders for 1 of 87 selected tests or treatments, the computer suggested corollary orders needed to detect or ameliorate adverse reactions to the trigger orders. The physicians could accept or reject these suggestions. Results: During the 6-month trial, reminders about corollary orders were presented to 48 intervention physicians and withheld from 41 control physicians. Intervention physicians ordered the suggested corollary orders in 46.3% of instances when they received a reminder, compared with 21.9% compliance by control physicians (p < 0.0001). Physicians discriminated in their acceptance of suggested orders, readily accepting some while rejecting others. There were one third fewer interventions initiated by pharmacists with physicians in the intervention than control groups. Conclusion: This study demonstrates that physician workstations, linked to a comprehensive electronic medical record, can be an efficient means for decreasing errors of omissions and improving adherence to practice guidelines.

UR - http://www.scopus.com/inward/record.url?scp=0031228345&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031228345&partnerID=8YFLogxK

M3 - Article

VL - 4

SP - 364

EP - 375

JO - Journal of the American Medical Informatics Association : JAMIA

JF - Journal of the American Medical Informatics Association : JAMIA

SN - 1067-5027

IS - 5

ER -