A randomized trial of "corollary orders" to prevent errors of omission

• HIT Description: Regenstrief Medical Record System testing the use of computer based reminders in the form of "corollary orders". The system is an electronic record which includes computer order entry, demographic information, diagnoses,problem lists, inpatient and outpatient visits; admitting, history, and physical examination reports; discharge summaries; vital signs; immunizations; giving nearly all diagnostic test results, procedures, and outpatient prescriptions. More info...
  
• Purpose of Study: Improve Quality
  
• Years of study: 1992-1993
  
• Study Design: RCT
  
• Outcomes: Utilization of services, length of stay, and health care costs
  

• Settings: This study was performed at an urban public tertiary-care teaching hospital on an inpatient general medicine service, which is staffed by faculty Internists and Internal Medicine house staff.
• Intervention: The authors identified 87 target orders involving 76 drugs and 11 tests, such as a trigger order for amino-glycocide therapy and a response or corollary order for measurement of drug levels and for measurement of serum-creatine. They randomized inpatient medical services to either receive these corollary orders as a pop-up screen at the time of the trigger order or to use the computerized electronic record without this added feature.
• Physician compliance outcomes: During the study, there were 2,181 different patients who made 2,955 admissions. Of these, 1,686 patients had at least one order written that would trigger a suggestion for a corollary order. On average, a trigger order generated suggestions for 1.5 corollary orders. The study reported that intervention physicians ordered the corollary orders required by the guidelines twice as often as control physicians did, as measured by immediate compliance (46.3% versus 21.9%) and as measured by 24-hour compliance or hospital-stay compliance (roughly 50% or more in the intervention group, versus 29-37% in the control group.)
• Length of stay and health care outcomes: The study reported that length of stay and total inpatient charges were not different for intervention patients compared with control patients.