title: Use of a computerized forcing function improves performance in ordering restraints.
abstract: OBJECTIVE
  We evaluate the effect of a computerized order entry system forcing function on improving timely renewal of restraint orders.
  
  
  METHODS
  In this prospective study of 2 successive interventions, physicians received computerized reminders to renew or discontinue restraint orders before their expiration. The initial intervention allowed acknowledgement of this reminder without further consequence, changing at 6 months to deny computer access until addressed. We performed chart review on emergency department visits with restraint orders in 3 consecutive 6-month periods (A, B, C) separated by these 2 interventions, determining time to order renewal, number of restraint orders, renewal orders per hour in restraints, and time in restraints and evaluating variability in these values across study intervals. Statistical analysis for our primary outcome used the Mann-Whitney and variance ratio tests.
  
  
  RESULTS
  Median time to order renewal decreased in periods B and C versus A by 64 and 56 minutes, respectively, with variability in this measure decreasing across all periods. Mean number of restraint orders in periods B and C significantly increased versus those in A (1.46 to 1.89 to 2.34), with corresponding increases in variability. Mean renewal orders per hour in restraint significantly increased in period C versus A and B, from 0.08 to 0.23 to 0.89, with increasing variability across all periods. Decreases in median time spent in restraints observed in periods B and C versus A of 45 and 105 minutes, respectively, trended toward but did not achieve significance, with significantly decreasing variability compared with baseline.
  
  
  CONCLUSIONS
  The forcing function improved restraint reordering and variability in practice and may have contributed to nonsignificant reductions observed in time in restraint.
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110-1010, USA. griffeyr@wustl.edu
authors.forename: Richard T
authors.initials: RT
authors.lastname: Griffey
authors.forename: Kathleen
authors.initials: K
authors.lastname: Wittels
authors.forename: Nicki
authors.initials: N
authors.lastname: Gilboy
authors.forename: Andrew T
authors.initials: AT
authors.lastname: McAfee
mesh_terms: D000328:Adult; D003625:Data Collection; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D011446:Prospective Studies; D017010:Reminder Systems; D012149:Restraint, Physical; D018709:Statistics, Nonparametric; D013996:Time and Motion Studies; D014584:User-Computer Interface