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Journal of the American Medical Informatics Association 4:364-375 (1997)
© 1997 American Medical Informatics Association

Research Paper

A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission

J. Marc Overhage, MD, PhD, William M. Tierney, MD, Xiao-Hua (Andrew) Zhou, PhD and Clement J. McDonald, MD

Affiliations of the authors: Regenstrief Institute for Health Care (JMO, WMT, XZ, CJM); Roudebush VA Medical Center (WMT); Department of Medicine, Indiana University School of Medicine (JMO, WMT, XZ, CJM), Indianapolis, IN.

Correspondence and reprints: Clement J. McDonald, MD, Regenstrief Institute for Health Care, 1001 West Tenth Street, RHC- 5th floor, Indianapolis, Indiana 46202-2859. E-mail: Clem{at}regen.rg.iupui.edu

Abstract Objective: Errors of omission are a common cause of systems failures. Physicians often fail to order tests or treatments needed to monitor/ameliorate the effects of other tests or treatments. The authors hypothesized that automated, guideline-based reminders to physicians, provided as they wrote orders, could reduce these omissions.

Design: The study was performed on the inpatient general medicine ward of a public teaching hospital. Faculty and housestaff from the Indiana University School of Medicine, who used computer workstations to write orders, were randomized to intervention and control groups. As intervention physicians wrote orders for 1 of 87 selected tests or treatments, the computer suggested corollary orders needed to detect or ameliorate adverse reactions 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 withheld from 41 control physicians. Intervention physicians ordered the suggested corollary orders in 46.3% of instances when they received a reminder, compared with 21.9% compliance by control physicians (p < 0.0001). 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 intervention than control groups.

Conclusion: This study demonstrates that physician workstations, linked to a comprehensive electronic medical record, can be an efficient means for decreasing errors of omissions and improving adherence to practice guidelines.




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