News release

From: BMJ Group

Duplicate medical records linked to 5-fold heightened risk of inpatient death

And 3-fold increased risk of intensive care need, US study indicates
Improvements needed in data integrity and health information management, say researchers

Patients with duplicate medical records are 5 times more likely to die after being admitted to hospital and 3 times more likely to require intensive care than those with a single medical record, reveals US research published online in the journal BMJ Quality & Safety.

The findings prompt the researchers to call for improvements in data integrity and policy changes in health information management to boost patient safety.

Duplication occurs when a single patient is assigned multiple medical record numbers within an electronic health record, and prevalence is thought to be between 5% and 10%, explain the researchers.

But while they are a source of fragmented care and information gaps, it’s not clear how duplicate medical records might affect health outcomes for patients, they add.

To find out, the researchers focused on key inpatient outcomes for adults up to the age of 89 who had been admitted to one of 12 partner hospitals within a large US multi-region health system between July 2022 and June 2023. The outcomes included hospital length of stay, 30-day readmission, emergency interventions, need for intensive care, and death while in hospital.

All the patients had been discharged from medical, surgical, or orthopaedic care teams. And during the study period, 103,190 medical records were reviewed, with 73, 275 patients eligible for inclusion. From this group, 6086 patients were identified:1698 had duplicate records and 4388 didn’t.

The researchers deployed a statistical technique called propensity score matching, which balances out similar characteristics in two different groups of people—-in this case with and without duplicate medical records.

Analysis of the results revealed that those with duplicate records had significantly higher odds of worse outcomes.

Inpatient death occurred in 11% of those with duplicate records compared with 2.5% of those without, and average length of stay lasted 101 hours compared with 74 hours.

Patients with duplicate charts more frequently required an emergency intervention (6% vs 5%) and they were more likely to need intensive care: 46% vs 19%. The 30-day readmission rate was also higher:12% vs 11%.

After adjusting for further potentially influential factors, such as destination and support needed at discharge, patients with duplicate records were 30% more likely to be readmitted to hospital.

And they were 3.5 times more likely to require intensive care, and almost 5 times more likely to die while in hospital than those without duplicate records. And their hospital stay was 32% longer.

This is an observational study, and as such, is unable to reach definitive conclusions about cause and effect, added to which, the researchers acknowledge various limitations to their findings. These include that they weren’t able to account for the number of diagnoses and healthcare encounters. And data from a single health system may limit the generalisability of the findings, they say.

“Despite these limitations, our study highlights a concerning association within our system and underscores the importance for outside systems to investigate their own associations, determine causal pathways, and develop mechanisms to prevent duplicate chart creation and/or conduct data integration expeditiously,” they write.

To explain the associations they found, the researchers suggest that duplication might prevent providers from accessing critical information, such as allergies or medical history, that could influence the type of treatment provided.

“An additional hypothesis relates to efficiency: the presence of duplicate charts may contribute to care delays or inaccurate orders as medical teams search for information that is not readily accessible, spend extra effort navigating between multiple charts, or inadvertently overlook key details,” they add.

“These findings highlight the association between duplicate medical records and adverse patient outcomes, emphasising the need for research to understand the impacts of duplicate charts as well as targeted interventions to improve data integrity, enhance patient safety, and inform policy changes in health information management,” they conclude.