Enhancing patient safety through electronic medical record documentation of vital signs

Abstract

As technology becomes more sophisticated in healthcare, there is increasing need to measure its impact on key quality indicators, such as error reduction, patient safety, and cost-benefit ratios. When a product is designed to decrease medical errors, the baseline error rate must be determined before implementation to accurately measure the impact. Given the opportunity to adopt a technology that would eliminate the need to manually document vital signs, a large Florida hospital decided to measure the current process and error rate of vital signs documentation. University Community Hospital in Tampa, Fla., designed a two-phase study to evaluate this process. Phase I of the study evaluated errors in the electronic medical record and traditional manual documentation. The results demonstrate that use of an EMR can reduce vital sign documentation errors by more than half compared with traditional manual documentation in paper charts. Researchers found the error rate for electronic vital signs documentation to be less than 5 percent, compared with the paper chart error rate of 10 percent.