A pragmatics' view of patient identification.

BACKGROUND: Patient identification is a central safety critical aspect of healthcare work. Most healthcare activities require identification of patients by healthcare staff, often in connection with the use of patient records. Indeed, the increasing reliance on electronic systems makes the correct matching of patients with their records a keystone for patient safety. Most research on patient identification has been carried out in hospital settings. The aim was to investigate the process of identification of patients and their records in the context of a primary healthcare clinic. METHOD: A qualitative field study was carried out at a Walk-In Centre in London (UK). RESULTS: The identification of patients and their records was found to be a context-dependent process, both when formalised in procedures and when relying on informal practices. The authors discovered a range of formal and informal patient identifiers were used in this setting, depending on the task at hand. The theoretical lens of Pragmatics was applied to offer an explanation of this identification process. CONCLUSIONS: Context provides the cognitive scaffolding for a process of 'suitably constrained guesswork' about the identity of patients and their records. Implications for practice and for system design are discussed. Practitioners and technology designers should be aware of the risk for misidentifications inherent in this natural information processing activity.

The challenging nature of patient identifiers: an ethnographic study of patient identification at a London walk-in centre.

The correct identification of a patient's health record is the foundation of any safe patient record system. There is no building of a ;patient history', no sharing or integration of a patient's data without the retrieval and matching of existing records. Yet there can often be errors in this process and these may remain invisible until a safety incident occurs. This article presents the findings of an ethnographic study of patient identification at a walk-in centre in the UK. We offer a view of patient identifiers as used in practice and show how seemingly simple data, such as a person's name or date of birth, are more complex than they may at first appear and how they potentially pose problems for the use of integrated health records. We further report and discuss a dichotomy between the identifiers needed to access health records and the identifiers used by practitioners in their everyday work.