A RANDOMIZED TRIAL OF COROLLARY ORDERS TO PREVENT ERRORS OF OMISSION

Objective: Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/a meliorate the effects of other tests or treatments. The authors hypoth esized that automated, guideline-based reminders to physicians, provid ed as they wrote orders, could reduce these omissions. Design: The stu dy was performed on the inpatient general medicine ward of a public te aching hospital. Faculty and housestaff from the Indiana University Sc hool of Medicine, who used computer workstations to write orders, were randomized to intervention and control groups. As intervention physic ians wrote orders for 1 of 87 selected tests or treatments, the comput er suggested corollary orders needed to detect or ameliorate adverse r eactions 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 with held from 41 control physicians. intervention physicians ordered the s uggested corollary orders in 46.3% of instances when they received a r eminder, compared with 21.9% compliance by control physicians (p < 0.0 001). 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 in tervention than control groups. Conclusion: This study demonstrates th at physician workstations, linked to a comprehensive electronic medica l record, can be an efficient means for decreasing errors of omissions and improving adherence to practice guidelines.