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N/A N=10,426 Randomized Health Services Research

Evaluating the Impact of Patient Photographs for Preventing Wrong-Patient Errors

Medical Errors · Electronic Medical Records

Enrolled (actual)
10,426
Serious AEs
0.0%
Results posted
Mar 2025
Primary outcome: Primary: Number of Order Sessions With at Least One Retract-and-Reorder (RAR) Event as Identified by the Wrong-Patient Retract-and-Reorder (RAR) Measure. — 5587; 5836; 5598; 6279 WP Order Sessions

Study Design & Population

Study type
Interventional
Phase
N/A
Interventions
Photo in Verification Alert (Behavioral); Photo in Banner (Behavioral); Photo in Banner and Verification Alert (Behavioral)
Age
Pediatric, Adult, Older Adult
Sex
All
Sponsor
Columbia University
Primary completion
Oct 2023

Outcome Measures

OutcomeResultp-value
PRIMARY
Number of Order Sessions With at Least One Retract-and-Reorder (RAR) Event as Identified by the Wrong-Patient Retract-and-Reorder (RAR) Measure.
5587; 5836; 5598; 6279

Summary

This is a multi-site, 4-arm randomized controlled trial to test the effectiveness of patient photographs displayed in electronic health record (EHR) systems to prevent wrong-patient order errors. The study will be conducted at several academic medical centers that utilize two different EHR systems. Because EHR systems have different functionality for displaying patient photographs, two different study designs will be employed. In Allscripts EHR, a 2-arm randomized trial will be conducted in which providers are randomized to view order verification alerts with versus without patient photographs when placing electronic orders. In Epic EHR, a 2x2 factorial trial will be conducted in which providers are randomized to one of four conditions: 1) no photograph; 2) photograph displayed in the banner only; 3) photograph displayed in a verification alert only; or 4) photograph displayed in the banner and verification alert. The main hypothesis of this study is that displaying patient photographs in the EHR will significantly reduce the frequency of wrong-patient order errors, providing health systems with the evidence needed to adopt this safety practice.

Eligibility Criteria

Inclusion Criteria

  • All patients for whom an order was placed in the study period.
  • All providers with the authority to place electronic orders and who placed electronic orders during the study period.

Exclusion Criteria

  • None
View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT03626766). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.

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