Displaying patient photographs in EHR reduced rate of wrong-patient order entry errors

As part of a quality improvement project at one Boston hospital, ED staff encouraged patients to have their photographs taken by informing them that the project was intended to improve safety.


A quality improvement initiative to display patient photographs in the banner of the electronic health record (EHR) was associated with a decreased rate of wrong-patient order entry errors in a recent cohort study.

Researchers analyzed data collected from patients who visited the ED of a large tertiary academic hospital in Boston from July 2017 through June 2019. The patient photo feature was available and enabled when the EHR was installed and, prior to this study, a small number of practitioners uploaded patient photos with their consent. The quality improvement campaign, which started in July 2018, aimed to expand the capture of patient photos in the ED by educating ED registration staff on the importance of patient photographs for identification and safety, providing equipment that enhanced the photo-taking process (e.g., switching from desktop computers with webcams to mobile devices), and inviting patient participation through posters in the waiting area. The primary outcome was the rate of wrong-patient order entry errors, measured with the wrong-patient retract-and-reorder (RAR) measure. Results were published Nov. 11 by JAMA Network Open.

The primary analysis comprised 2,558,746 orders, of which 596,346 (23.3%) were placed while the patient's photo was displayed to the practitioner. These orders were placed for 71,851 unique patients (mean age, 49.2 years; 59.4% women). The overall rate of RAR events was 186 per 100,000 orders for the no-photo group and 133 per 100,000 orders for the photo group (unadjusted odds ratio [OR], 0.72; 95% CI, 0.57 to 0.89). After adjustment for multiple variables (e.g., patient race/ethnicity, practitioner type, emergency severity index), the reduced rate of RAR events remained consistent in the photo group compared to the no-photo group (OR, 0.57; 95% CI, 0.52 to 0.61). Patients with the highest level of acuity had significantly lower odds of wrong-patient orders but were also less likely to end up in the photo group. In addition, White race/ethnicity was associated with a lower rate of wrong-patient errors compared to Black race/ethnicity (OR, 0.91; 95% CI, 0.84 to 0.98).

Limitations of the study include its single-center, quasi-experimental design and the fact that the two groups had significant differences in patient acuity, the study authors noted. They added that results may be different at other institutions, particularly those using a different EHR system.

The authors noted the relatively low costs of the intervention: less than $1,600 to purchase devices and accessories for the study and a projected $1,000 per year to maintain and replace equipment. “We speculate that the expected savings from improved safety, although not measured, likely far exceed the minimal costs of this program,” they wrote.

A Success Story in the March 2013 ACP Hospitalist also reported that adverse events related to patient misidentification at one hospital decreased after staff began taking photos of patients upon admission or registration.