POTENTIAL IDENTIFIABILITY AND PREVENTABILITY OF ADVERSE EVENTS USING INFORMATION-SYSTEMS

Study Objective: To evaluate the potential ability of computerized inf ormation systems (ISs) to identify and prevent adverse events in medic al patients. Design: Clinical descriptions of all 133 adverse events i dentified 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 medicat ions would be available on-line; Level 2-all orders would be entered o n-line by physicians; and Level 3-additional clinical data, such as au tomated 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: O f all the adverse events, 53% were judged identifiable using Level 1 i nformation, 58% were judged identifiable using Level 2 information, an d 89% were judged identifiable using Level 3 information. The highest- yield event monitors for identifying adverse events wee ''panic'' labo ratory results, unexpected transfer to an intensive care unit, and hos pital-incurred trauma. With information from Levels 1, 2, and 3, 5%, 1 3%, and 23% of the adverse events, respectively, were judged preventab le. For preventing these adverse events, guided-dose algorithms, drug- laboratory checks, and drug-patient characteristic checks held the mos t potential.