The Use of Individual Performance Metrics to Reduce Prescription Errors in the Emergency Department

Abstract

Introduction: The study emergency department (ED) receives a new cohort of junior doctors every 6 months as part of the national manpower allocation to meet health service needs. An approach to effect a consistent reduction in prescribing errors by these doctors during their 6-month postings at the study ED was introduced in May 2009. Methods: Monthly broadcasting of prescribing error counts by individual doctors allowed performances to be openly benchmarked against one another while providing a reference for self-improvement. The monthly tally of absolute counts were computed into a pre-determined formula and translated into monetary rewards for the junior doctors. Control charts of total count per month, mean count per doctor per month and highest individual count per month were plotted based on a total of 48 data points for 8 cohorts over 4 years from May 2007 to April 2011. Results: There was a shift towards fewer absolute counts and lower mean count of prescribing errors per month in the post-intervention phase, suggesting a positive impact of the intervention on the doctors as a cohort. The intervention's impact on individual performances, however, was less convincing with minimal change in variation in the highest individual count per month over the 4 years. Conclusion: The use of metrics has helped to drive and sustain a reduction in prescribing errors among junior doctors as a cohort during their 6-month postings in the study ED.