Protocol-Based Computer Reminders, the Quality of Care and the Non-Perfectability of Man

TLDR

The protocols addressed conditions such as elevated blood pressure and drug‑induced liver toxicity. The study aimed to assess whether prospective computer suggestions reduce clinical errors by evaluating nine physicians' responses to 390 protocol‑generated prompts. Nine physicians responded to 390 protocol‑generated computer suggestions in a controlled crossover design. Physicians responded to 51 % of events with computer suggestions versus 22 % without, indicating that prospective reminders reduce errors, largely attributable to human data‑processing limits rather than training differences.

Abstract

To determine whether clinical errors can be reduced by prospective computer suggestions about the management of simple clinical events, I studied the responses of nine physicians to computer suggestions generated by 390 protocols in a controlled crossover design. These protocols dealt primarily with conditions managed (e.g., elevated blood pressure) or caused (e.g., liver toxicity) by drugs. Physicians responded to 51 per cent of 327 events when given, and 22 per cent of 385 events when not given computer suggestions. Neither level of postgraduate training (first-year postgraduate or third-year post-graduate) nor the order in which physicians served as study and control subjects had statistically significant overall effect on the results. It appears that the prospective reminders do reduce errors, and that many of these errors are probably due to man's limitations as a data processor rather than to correctable human deficiencies.