An overarching health network recently integrated its electronic outpatient and inpatient records. A 64-year-old man undergoes a successful total knee arthroplasty. Four weeks postoperatively, he presents to the emergency department with a massive gastrointestinal hemorrhage. His admission hemoglobin is 5.2 g/dL. Chart review demonstrates that a pre-surgical basic metabolic panel and complete blood count had flagged a hemoglobin of 9.4 g/dL and a mean corpuscular volume of 72 fL. The orthopedic team noted the anemia in the preoperative history and physical but attributed it to "anemia of chronic disease" from osteoarthritis, proceeding with surgery without further evaluation. The patient had not seen a primary care physician in five years. To systematically mitigate the risk of abnormal, non-orthopedic laboratory values being overlooked or misattributed in the perioperative setting, leadership decides to apply human factors engineering principles. Which of the following represents the most reliable, highest-leverage system intervention?
- Configuring the electronic health record to automatically generate a gastroenterology e-consult and route an inbox message to the primary care provider when unexplained microcytic anemia is detected.Answer
- BProgramming an unbypassable electronic pop-up window that requires the attending surgeon to type a free-text justification for proceeding with surgery whenever the hemoglobin falls below a defined threshold.
- CImplementing a mandatory physical checklist requiring the preoperative holding nurse to verbally confirm with the anesthesia provider that all out-of-range laboratory values have been addressed.
- DTemporarily suspending the operating room block time for surgical attendings who repeatedly fail to initiate diagnostic workups for significant incidental laboratory abnormalities.
- EInstituting a mandatory, annual continuing medical education module for the orthopedic surgery department focused on differentiating types of anemia and their preoperative implications.