The EMR has not lived up to its promise of improving patient safety and quality. Reasons for this might include the fact that the process “improvements” to this point in our experience with the EMR are weak and loaded with unintended consequences. More sophisticated tools will need to be embedded into EMRs before they deliver robust process improvements.
One such idea was recently reported in Critical Care Medicine. The EMR monitored mechanically ventilated patients. Providers were alerted via text page in real time when potentially injurious ventilator settings or measurements were detected. The results:
Findings: The prevalence of acute lung injury was 42% (n = 490) among 1,159 patients receiving greater than 24 hrs of invasive ventilation. The system sent 111 alerts for 80 patients, with a positive predictive value of 59%. The exposure to potentially injurious ventilation decreased after the intervention from 40.6 ± 74.6 hrs to 26.9 ± 77.3 hrs (p = .004).
Interpretations: Electronic medical record surveillance of mechanically ventilated patients accurately detects potentially injurious ventilator settings and is able to influence bedside practice at moderate costs. Its implementation is associated with decreased patient exposure to potentially injurious mechanical ventilation settings.
This is a novel idea and attempts to use the EMR for all it’s worth. We need a good deal more experience with ideas such as this before the EMR will become a real quality and safety tool.