• Brian E Driver, Sarah K Scharber, Erik T Fagerstrom, Lauren R Klein, Jon B Cole, and Ramnik S Dhaliwal.
• Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
• J Emerg Med. 2019 Jan 1; 56 (1): 109-113.

BackgroundHealth care systems often implement changes within the electronic health record (EHR) to improve patient safety and reduce medical errors.ObjectiveTo compare the proportion of emergency department (ED) encounters with laboratory tests resulting subsequent to patient discharge before and after a clinical decision support was implemented.MethodsIn 2015, our institution added an EHR dialogue when placing ED discharge orders, requiring providers to declare whether all laboratory results had been reviewed. To determine the effectiveness of this initiative, we searched the EHR to identify the proportion of ED encounters with laboratory tests resulting after discharge in pre- (January to June 2015) and post-intervention (January to June 2016) periods.ResultsThere were 67,287 discharged patients during the study periods. In the pre- and post-intervention periods, respectively, 6.9% (95% confidence interval [CI] 6.7-7.2%) and 7.9% (95% CI 7.6-8.2%) of encounters had laboratory tests resulting after discharge, with an absolute difference of 0.9% (95% CI 0.5-1.3%). Of these patients with laboratory tests resulting after ED discharge, in 92% the provider inaccurately marked "yes" or "not applicable" to the EHR dialogue prompt.ConclusionsThis workflow intervention was associated with an increase in the proportion of laboratory tests resulting after ED discharge; inaccurate answers to the EHR dialogue were pervasive. EHR workflow interventions do not always accomplish their intended goals, and their implementation should be considered thoughtfully.Copyright © 2018 Elsevier Inc. All rights reserved.

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