title: Automated electronic reminders to prevent miscommunication among primary medical, surgical and anaesthesia providers: a root cause analysis.
abstract: In this case report, the authors present an adverse event possibly caused by miscommunication among three separate medical teams at their hospital. The authors then discuss the hospital's root cause analysis and its proposed solutions, focusing on the subsequent hospital-wide implementation of an automated electronic reminder for abnormal laboratory values that may have helped to prevent similar medical errors.
authors: Department of Anesthesiology, 1H247 Box 0048, University of Michigan Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. freundli@med.umich.edu
authors: Robert E
authors: RE
authors: Freundlich
authors: Louise
authors: L
authors: Grondin
authors: Kevin K
authors: KK
authors: Tremper
authors: Kelly A
authors: KA
authors: Saran
authors: Sachin
authors: S
authors: Kheterpal
mesh_terms: D000761:Anesthesia Department, Hospital; D006801:Humans; D007400:Interprofessional Relations; D016347:Medical Records Systems, Computerized; D017010:Reminder Systems; D060891:Root Cause Analysis; D000078329:Workforce