International journal of medical informatics
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Medication errors in hospital discharge summaries have the potential to cause serious harm to patients. These errors are generally associated with manual transcription of medications between medication charts and discharge summaries. Studies also show junior doctors are more likely to contribute to discharge medication error rates. Electronic discharge summaries have the potential to reduce discharge medication errors to ensure the safe handover of care to the primary care provider. ⋯ Similar medication error rates in handwritten and electronic summaries may be due to the common factor of transcription, either handwritten or typed, known to be associated with medication errors. Clinical information systems evolve and often in the early stages of implementation electronic discharge summaries are integrated with existing paper-based patient record systems. Automatic transfer of medications from an electronic medication management system to the electronic discharge summary holds the potential to reduce medication errors through the elimination of the transcription process.
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Breakdowns in communication and coordination are situations of mismatch between actual and expected conditions in joint activities. Breakdowns have been identified as the leading cause of adverse events in healthcare, especially in the Operating Room environment. As a result, researchers have started to examine breakdowns in healthcare as emergent dynamics of teamwork. However, the occurrence and consequences of breakdowns related to inter-team processes are yet to be addressed at a fine level of detail. In this paper we seek understanding of breakdowns at the systemic level, and its relevance to design. ⋯ This study achieved an initial understanding of the deep features of breakdowns from a process-oriented perspective, which allowed us to build the groundwork for a theoretical model of breakdowns in perioperative activities and to propose a design approach that tackles breakdowns during early stages of system development. The direct association between breakdowns and repairs can be exploited in both IT-system design and organizational design. The patterns of repair work can inform design so as to provide clinicians with the types of information that will prevent breakdowns from occurring or to mitigate the impact of breakdowns. The results reveal that preventing breakdown propagation should be a prime target in surgical applications design.