Participation in EHR based simulation improves recognition of patient safety issues

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A review of the article by Stephenson et al., Participation in EHR based simulation improves recognition of patient safety issues


Electronic Health Record (EHR) usage is prevalent in all aspects of healthcare today with several studies showing an increase in adverse patient safety issues due to the EHR-user interface. The ICU is a high volume, critical arena vulnerable to patient safety concerns due to EHR related safety issues. Stephenson et al., stated novel educational activities which incorporate use of the EHR can be used to address the concerns.[1] The researchers used EHR based simulation exercises to show that everyday users failed to recognize most of patient safety issues in the ICU. They next sought to determine whether participation in the simulation[2] improved recognition of the patient safety issues.


Health Information Technology for Economic and Clinical Health (HITECH) supported the adoption of EHRs and meaningful use. From 2008 to 2012, EHR usage in US hospitals increased from 9.4% to 44.4% and the percent of hospitals adopting a comprehensive EHR increased from 1.6% to 16.9%. The researchers stated an ICU patient generates more than 1400 data items per 24 hour period, excluding clinical notes, medication orders and details of medication administration.[1]


The authors created a simulated patient environment within their EHR with a detailed method of the simulation exercise for evaluating use of the EHR in the ICU. They later created a second simulated medical ICU patient with a different clinical scenario and different trends. Each case contained 14 safety issues with shared themes but different content. The subjects were given 10 minutes to review a case followed by a presentation of management changes. Participants were given an immediate debriefing regarding missed issues and strategies for data gathering in the EHR, followed by retesting 1 week to 1 month later with the other case.


A total of 116 subjects were initially tested with 25 undergoing repeat testing. The researchers did not notice a difference between the initial cases in the recognition of patient safety issues (39.5% vs. 39.4%). There was no significant difference in the baseline performance of those participating in repeat testing compared to the cohort as a whole. For both case scenarios, recognition of safety issues was significantly higher for repeat participants as they outperformed all first time only participants regardless of training level. [1]


The authors concluded participation in EHR simulation improved overall EHR use and identification of patient safety issues. The article did not identify whether the improvement in performance was due to improved utilization of the EHR or was from the redundancy of exposure to the clinical information by those who participated in the study.


The authors believed the identification of patient safety issues improved with repeated simulation and the increase was credited to the simulation itself. I believe the repetition of exposure to information through the retesting contributed more to the improvement.


  1. 1.0 1.1 1.2 Stephenson, L., Gorsuch, A., Hersh, W., Mohan, V., & Gold, J. (2014). Participation in EHR based simulation improves recognition of patient safety issues. BMC Medical Education, 14, 224.,f1000m,isrctn.

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