ABSTRACT
Computerized physician order entry (CPOE) has had demonstrated benefits in error reduction and guideline adherence, but its implementation has often been complicated by disruptions in established workflow processes. We conducted an observational study of the healthcare team in an intensive care unit after the implementation of mandatory CPOE. We found that policies designed to increase flexibility and safety led to an increased coordination load on the healthcare team, and created opportunities for new sources of error. We attribute this in part to implicit assumptions in the CPOE system design that execution of physician orders is a linear work process. Observational workflow studies are an important tool to understand how to redesign CPOE systems so as to avoid harm and achieve the full potential of benefit for improved patient safety.
Subject(s)
Hospital Information Systems , Intensive Care Units/organization & administration , Medical Records Systems, Computerized , User-Computer Interface , Attitude of Health Personnel , Attitude to Computers , Clinical Pharmacy Information Systems , Humans , Medication Systems, Hospital , Models, Organizational , Patient Care TeamABSTRACT
A rare case of severe liver disease in a patient with systemic sarcoidosis is reported. The liver pathology progressed from sarcoid granulomas early in the course to chronic active hepatitis and cirrhosis with complicating portal hypertension and bleeding esophageal varices. The literature on portal hypertension due to hepatic sarcoidosis is reviewed and the role of coexisting disease, portasystemic shunts, and steroid therapy is discussed.
