Clinical error rates should be less than 1 percent to make important progress towards eliminating threats to patient safety. Unfortunately, the impact of clinical practice guidelines, education, and other efforts falls far short of this goal. One way to improve treatment, reduce errors, and increase quality of care is through the use of computerized protocols at the point of care, suggests Alan H. Morris, M.D., of LDS Hospital in Salt Lake City, UT. His research was supported in part by the Agency for Healthcare Research and Quality (HS06594).
In a recent commentary, he notes that many, if not most, clinical errors result from system problems. Humans cannot be relied upon consistently to render decisions that comply with evidence-based recommendations. For example, traditional screening for in-hospital adverse drug events detects only 1 percent and voluntary reporting only 12 percent of the adverse drug events detected by automated computerized screening of an integrated electronic clinical database. Simple computerized algorithms that generate reminders, alerts, or other information and protocols that incorporate more complex rules reduce the clinical decision error rate.
When explicit computerized protocols are driven by patient data, the output is a patient-specific protocol (instructions), thus preserving individualized treatment while standardizing clinical decisions. The expected decrease in clinical practice variation and increase in compliance with evidence-based recommendations should lower the error rate and enhance patient safety, concludes Dr. Morris.
See "Decision support and safety of clinical environments," by Dr. Morris, in Quality and Safety in Health Care 11, pp. 69-75, 2002.