Summer Internship Leads to Presentation at National Meeting
Innovative research on hospital medication errors produces valuable findings
WOOSTER, Ohio — Summer internships at Children’s Hospital of Pittsburgh (University of Pittsburgh Medical Center/UPMC) are hard to come by. Most are reserved for medical school students or upper-level graduate students, but Hannah Levin, a junior psychology major from Sewickley, Pa., had a couple of advantages in her pursuit of a position — a broad base of research experience at The College of Wooster and a father in the medical field.
James E. Levin, who holds a PhD as well as a degree in medicine, is the Chief Medical Information Officer at the hospital. He has high standards for scientific research, and he wasn’t willing to turn over a project to just anyone — even his daughter. “I work with medical and doctoral students all the time,” he said. “My expectations are very high. Hannah had to measure up to those standards in order to be considered.”
Her formal application was accepted by a review committee, and she was assigned to her first choice of projects — one led by her father and Dr. Steve Docimo, the hospital’s Chief Medical Officer and a professor at the University of Pittsburgh School of Medicine. The research team also included hospital pharmacists and patient-safety specialists.
The topic — the unintended consequences of Computerized Physician Order Entry (CPOE), which, while improving care and decreasing errors overall has introduced new types of errors — had interested Dr. Levin for quite some time. Now he would have a chance to study it with his daughter.
Each day, he and Hannah would carpool from home to the hospital where Hannah had a cubicle in which she conducted the research. “I saw my father just about every day at the hospital,” she said. “He would stop and look at what I had done. I loved working with him. It was fun to talk about the research.”
During the eight-week internship, Hannah analyzed 2.4 million medication orders over a five-year period and identified 644 error episodes. She manually reviewed 200 patient records to validate her findings. “Physicians almost never report an error that they catch immediately and doesn’t reach the patient,” said Dr. Levin. “That would be like filling out a form every time you make a typographical error. Because of this, Hannah needed to invent a new process to infer whether it was an error.
“She spent a lot of time going through the process, reviewing the literature, and doing the qualitative and quantitative research,” added her father. “By the end of the project, she had learned to design a study, write a scientific paper, and have it reviewed by two or three experts in the field.”
Very little research had been done on these types of errors, so the Pittsburgh research team took it upon themselves to identify the risk factors and the number of incidents as well as what factors increase the likelihood of patient misidentification. They looked at a range of variables, including common age and sex of the patients and day and time of the week. What they came up with was an innovative case-control study to identify risk factors and compare them statistically. Their findings included the fact that errors are twice as likely to occur on Fridays as Mondays. They also learned that patients with similar last names (e.g. McCormick and McCutcheon) are often mistaken for one another. In addition, they discovered that patients in nearby rooms are at risk for error based on misidentification.
The result was a paper, titled “I meant that med for Baylee not Bailey!” a mixed-method study to identify incidence and risk factors for CPOE patient misidentification, which was presented by Hannah earlier this month in Chicago at the annual meeting of the American Medical Informatics Association, a group that focuses on using information technology to improve health care. The ultimate goal is to better understand how electronic records can be improved by reducing patient misidentification errors.
“Hannah accomplished what is expected of a seasoned researcher,” said Dr. Docimo. “She identified a significant problem, formulated a hypothesis, created and honed her study design, verified her results in multiple ways, and most importantly made a discovery that will make hospitals safer places.”
Enriched by her experience, Hannah will now set her sights on her junior and senior Independent Study Project, Wooster’s nationally acclaimed mentored undergraduate research program, which is required of all students. She then plans to attend graduate school.
Meanwhile, her father is still beaming about his daughter’s presentation in Chicago, and delighted that she chose to attend Wooster. “I went to Princeton as an undergraduate, so I know the value of undergraduate research,” he said. “Our family believes strongly in liberal arts colleges, especially Wooster where students conduct research and present papers.
“In my field, technology changes quickly,” he added. “We struggle to find those who think critically and communicate well. We really like Wooster because of its emphasis on research and independent thinking.”