Analysis of Daily Laboratory Orders at a Large Urban Academic Center: A Multifaceted Approach to Changing Test Ordering Patterns.

Objectives: We sought to address concerns regarding recurring inpatient laboratory test order practices (daily laboratory tests) through a multifaceted approach to changing ordering patterns.

Methods: We engaged in an interdepartmental collaboration to foster mindful test ordering through clinical policy creation, electronic clinical decision support, and continuous auditing and feedback.

Results: Annualized daily order volumes decreased from approximately 25,000 to 10,000 during a 33-month postintervention review.

Effectiveness of interruptive alerts in increasing application functionality utilization: a controlled trial.

Medical applications frequently contain a wide range of functionalities. Users are often unaware of all of the functionalities available. More effective ways of delivering information about available functionalities to the users are needed.

Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial.

Background: Medication reconciliation at transitions in care is a national patient safety goal, but its effects on important patient outcomes require further evaluation. 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]).

Methods: We performed a controlled trial, randomized by medical team, on general medical inpatient units at 2 academic hospitals from May to June 2006.

Classifying and predicting errors of inpatient medication reconciliation.

Background: 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.

Objective: To determine the reasons, timing, and predictors of potentially harmful medication discrepancies.

Evaluation of an inpatient computerized medication reconciliation system.

We designed the Pre-Admission Medication List (PAML) Builder medication reconciliation application and implemented it at two academic hospitals. We asked 1,714 users to complete a survey of their satisfaction with the application and analyzed factors associated with user efficiency. The survey was completed by 626 (36.

The use of electronic medication reconciliation to establish the predictors of validity of computerized medication records.

Medication records in clinical information systems (CIS) are frequently inaccurate, leading to potentially incorrect clinical decisions and preventing valid decision support interventions. It is not known what characteristics of electronic medication records are predictive of their validity. We studied a dataset of 136,351 electronic medication records of patients admitted to two academic hospitals that were individually validated by admitting providers using novel medication reconciliation software.

Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network.

Confusion about patients' medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation.

Upper extremity musculoskeletal symptoms and functional impairment associated with computer use among college students.

Purpose: Occupational computer use has been associated with upper extremity musculoskeletal disorders among working-age adults, but little is known about computer-related musculoskeletal problems among college students. We carried out a descriptive epidemiological study of computer use-associated symptoms, functional limitations, and medication and health care utilization in this population.

Subjects And Methods: Cross-sectional survey of 240 undergraduates in the second through fourth years at a residential dormitory at a four-year college with random housing assignments.

Community-acquired pneumonia and do not resuscitate orders.

Objectives: From a cohort of patients with community-acquired pneumonia (CAP) who required admission to hospital, to describe the subset of patients having a do not resuscitate (DNR) order and to compare them with those who did not have such an order.

Design: Retrospective subset analysis of data from the pneumonia patient outcomes research team study.

Setting: Three hospitals in the United States and one in Canada.

Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study.

Background: To our knowledge, no previous study has systematically examined pneumonia-related and pneumonia-unrelated mortality. This study was performed to identify the cause(s) of death and to compare the timing and risk factors associated with pneumonia-related and pneumonia-unrelated mortality.

Methods: For all deaths within 90 days of presentation, a synopsis of all events preceding death was independently reviewed by 2 members of a 5-member review panel (C.

Assessment of upper extremity role functioning in students.

Background: Upper extremity symptoms associated with use of computers and other upper extremity activities are common in students. Research on these disorders requires psychometrically sound measures of health-related student role function; no such measure is available currently.

Methods: Based upon input from students and clinicians, we developed a 10-item scale to measure student health-related role function.