A few months ago, I received a notice in the mail that a referral to a specialist had been generated in my name and my insurance company had authorized three visits. The letter was disturbing for two reasons: the doctor that referred me wasn’t my primary care doctor (and never had been) and the diagnosis prompting the specialist visit wasn’t anything I had. My first, panicked thought was that someone was using my identity to get medical care.
When I called the clinic to follow up, I discovered it wasn’t a case of medical identity theft, rather poor patient identification. My account was pulled up in the electronic health record in error and the documentation and need for a referral belonged to someone else. I wondered how many people had been involved in this mistake, how much documentation was incorrectly entered in my medical chart, and why no one caught it prior to the letter being sent out. I mean, I had to be registered in the system in order for someone to bring me up in their schedule and I needed to have a note in my chart in order for the referral people and specialists to judge how quickly I needed to be seen. At one point in the process you’d think someone would have checked a name and date of birth, a simple task which could have resulted in the right patient getting the referral.
The current standard for identification of patients is to ask people to state their date of birth and full name at every stage of the process: when an appointment is booked, when the patient checks in, when the patient is put in a room, when the doctor sees the patient, and before any injections or treatment. A lot of work, right? But clearly, when the process isn’t followed, mistakes occur.
In the world of electronic health records, multiple electronic charts can be open on a desktop at one time and it’s easy to err and document in the wrong one. Some of these errors are annoying, like my referral, some of them catastrophic, like the deaths of patients who received blood transfusions not meant for them.
How does this happen in a world where patient identification is mandated by accrediting agencies and where hospital inpatients wear identifying wristbands? Wristbands can have incorrect information or fall off. Hurried staff members may verify patient information by stating the patient’s name and date of birth and asking if it is correct. In looking at errors in patient identification, there are myriad ways in which people are misidentified in a busy work environment. As a nurse, I’ve been in more than one situation where the patient in the room isn’t the patient I expected.
Even in patient simulation exercises (where healthcare workers are aware their actions are being filmed and scrutinized) patient identification errors persist. One study involved three simulated patients, two with patient identification data that matched the task paperwork and one that had a discrepancy in the date of birth and medical record between the patient identification data and the task paperwork. Thirty-nine percent of the healthcare workers performed the assigned task on the incorrectly identified, wrong patient
(http://www.ncbi.nlm.nih.gov/pubmed/20031263. It’s probably a safe bet that the percentage would be higher in the high pressure atmosphere of daily practice.
The solution? There isn’t an easy one to this complex issue. Healthcare can’t force people to do their job correctly (at least they haven’t been able to so far). Electronic health records offer many benefits, but also more opportunity for error. Involving patients in their care is key, but anxiety, physical limitations such as dementia or hearing loss, and the persistent belief that “the doctor is always right” prevent many patients from asking questions about their medical treatment.
Instead of depending on an overburdened, mistake prone healthcare system to do the right thing, patients have to actively engage in keeping themselves safe. You’d argue with a mechanic who told you he planned to fix the brakes on your car when you came in for a new windshield wipers. Don’t be afraid to question the people who deliver your healthcare. It could save your life.