Table 1

Synopsis of 24 identified studies

AuthorCountryRCTInterventionType of safety metricUnit of measurementImpact
AbramsonUSANoTransition between EHRsMedication safetyCliniciansn.s.
AdelmanUSAYesChange in version of EHRSystem safety: wrong patient ordersCliniciansIdentification-re-entry function resulted in lower error rate (p<0.001).
AwdishuUSAYesNotification: AKIMedication safety: AKICliniciansAdjusted prescriptions increased (p<0.001).
BarnettUSANoTransition between EHRsAdverse event reporting: PSI-90, death and readmissionsPatientsn.s.
BoockvarUSAYesLink to community EHRMedication safety: ReconciliationPatientsn.s.
CardozoUSANoNotification: TraumaClinical pathway: cervical-spine clearance protocolPatientsImproved compliance rate with pathway.
ChoUSANoEHR generated listsAlertsClinical unitReduction in catheter related infections (p<0.05).
ChoKoreaNoNotification: Falls risk assessmentFallsPatientsUnchanged rate of falls.
ColpaertBelgiumNoTransition to electronic systemMedication safetyPatientsReduction in prescription errors (p<0.001).
CookUSANoTransition to electronic systemMedication safety: antibiotic prescribingPatientsReduction in nosocomial infections (p<0.07).
DowdingUSANoTransition to electronic systemHospital acquired pressure ulcers and fallsPatientsIncreased documentation rates for hospital acquired pressure ulcers.
FaheyUSANoChange in version of EHRMedication safety: wrong dosage of chemotherapyCliniciansDecrease in dosage error (n=0) compared with manual rounding (n=4).
HessUSANoTransition from paper to electronic systemMedication safety: wrong dosage in chemotherapyCliniciansn.s.
MishraUSANoNotification: Medication dosageMedication safety: monitoring of Vancomycin dosagePatientsIncrease in frequency of trough levels (p<0.01).
MohsenUSANoChange in version of EHRVenous thrombembolism Reduction in inappropriate alertsPatientsAlert reduction (p<0.001), increase in alert effectiveness (p<0.001), but decrease in alert efficiency (p=0.007).
MuhlenkampUSAYesNotification: Dosage alertsMedication safety: removal of inappropriate or unnecessary alertsPatientsDecrease in dosage alerts by 3.6%.
NanchalUSAYesChange in version of EHRICU handover: occurrence of non-routine eventsCliniciansStructured sign-out process reduced the occurrence of non-routine events reported by residents (p=0.005).
NendazSwitzerlandYesNotification: VTE risk assessmentMedication safety: decision support for VTE prophylaxisPatientsLess overprescribing with e-alerts (p<0.01).
SchnipperUSAYesMedication ReconciliationMedication safety: adverse drug eventsPatientsChanges significant at discharge but not admission.
SilbernagelSwitzerlandYesNotification: Complications of Atrial fibrillationMedication safety: anticoagulationPatientsAdequate prescription increased from 16% to 22% (p=0.021).
SpirkSwitzerlandYesNotification: VTE prophylaxisMedication safety: VTE prophylaxisPatientsn.s.
WeissUSAYesChecklist in EHRMedication Safety: Antibiotic prescribingPatientsIncrease in number of days with empirical antibiotics (p<0.002).
WestbrookAustraliaNoImplementation of two EHRsMedication SafetyPatients44% reduction in serious errors, increase in system errors.
WilsonUSAYesNotification: AKIMedication Safety: AKIPatientsIncrease in creatinine checks (p<0.05) and reduction in deaths and dialysis (p<0.01) only in surgical stratum.
  • AKI, acute kidney injury; EHR, electronic health record; ICU, intensive care unit; n.s., not significant; PSI, Patient Safety Indicator (PSI-90); PSI-90, Patient Safety and Adverse Events Composite for the International Classification of Diseases; RCT, randomised controlled trial; VTE, venous thromboembolism.