Applying technology can both help and hinder patient safety
Technological advances have opened new possibilities for improving patient safety. Using technology to digitize healthcare processes has the potential to increase standardisation and efficiency of clinical workflows, and to reduce errors and cost across all healthcare settings. However, if technological approaches are designed or implemented poorly, the burden on care providers can increase.
This article draws from key studies and articles published over 2022 on the role of technology in patient safety, presenting a range of positive and negative perspectives. As expected, clinical decision support features with a focus on medication prescription and administration.
Wrong patient, wrong dose, wrong medication, wrong route, and wrong-frequency medication orders can be avoided or at least reduced through effective clinical decision support systems. However, errors can still occur and even be caused by the systems themselves. One study reviewed duplicate medication orders and found that 20% of duplicate orders resulted from technological issues, including alerts being overridden, alerts not firing, and automation issues (e.g., prefilled fields).
Poor decision-support systems that don’t fit into existing workflows lead to frustrated users and increase the potential for errors. For example, if users are required to enter data in multiple places or prompted to enter data that are not available to them, they may find ways to work around the system or even cease to use it, increasing the potential for patient safety errors.
There are also studies that showed successful outcomes of well-implemented systems. One showed that a fully implemented system significantly reduced specific serious and commonly occurring prescribing and procedural errors. A specific function that demonstrated statistically significant safety improvement was automatic de-prescribing of medication orders and communication of the relevant information to pharmacies.
The role of AI in patient safety is also discussed. Research in 2022 showed that these techniques are starting to be integrated into electronic health records and other systems, but challenges remain. One of the promising aspects of AI is its ability to improve clinical decision processes and clinician workflow overall. For example, a study looked at using machine learning to improve and filter decision-support alerts. They found that the software could reduce alert volume by 54% while maintaining high precision. Reducing alert volume has the potential to alleviate alert fatigue and habitual overriding by clinicians.
Despite enthusiasm for the promising applications of AI, implementation is slow. One of the challenges facing implementation is the variable quality of the systems. It is clear that AI is not a “set it and forget it” application; it requires monitoring and customisation from a dedicated resource to ensure that the algorithms perform well over time.
We have a way to go before the benefits of technology on safety are fully realised.
All accessed 5/3/2023:
Gale, B et al. Technology as a Tool for Improving Patient Safety. Patient Safety Network Annual Perspective. AHRQ, March 29, 2023 https://psnet.ahrq.gov/perspective/technology-tool-improving-patient-safety