Heather L. Heiman

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CONTEXT Warfarin is highly effective in preventing thromboembolism, but increases the risk of hemorrhage, particularly at an international normalized ratio (INR) greater than 4.0. Identifying causes of excessive anticoagulation in clinical practice could help target patients at risk for elevated INRs. OBJECTIVE To determine causes of INRs greater than 6.0(More)
BACKGROUND Oral case presentations are critical for patient care and student assessment. The best method to prepare early medical students for oral presentations is unknown. AIM We aimed to develop and evaluate a curriculum of on-line learning and deliberate practice to improve pre-clinical students' case presentation skills. METHODS We developed a(More)
Design: A cohort study including 424 randomly selected admissions to the medical services of an academic medical center was conducted between January and July 2000. The authors developed a computerized screening tool that searched free-text discharge summaries for trigger words representing possible adverse events. Measurements: All discharge summaries with(More)
BACKGROUND Since 1991, hospitals have asked patients whether they have advance directives, but few patients complete these documents. We assessed two simple interventions to improve completion of advance directives among elderly or chronically ill outpatients. METHODS We conducted a cluster randomized controlled trial involving 1079 patients from five(More)
BACKGROUND Medical students are increasingly documenting their patient notes in electronic health records (EHRs). Documentation short-cuts, such as copy-paste and templates, have raised concern among clinician-educators because they may perpetuate redundant, inaccurate, or even plagiarized notes. Little is known about medical students' experiences with(More)
OBJECTIVES Studies show singular handoffs between health care providers to be risky. Few describe sequential handoffs or compare handoffs from different provider types. We investigated the transfer of information across 2 handoffs using a piloted survey instrument. We compared cross-cover (every fourth night call) with dedicated night-shift residents. (More)
PURPOSE Patients' knowledge of the indications of their prescription medications was studied and those medications that were most likely to be taken without patients understanding the correct indication were identified. METHODS Adult patients who received care at four primary care practices were surveyed. Patients were eligible to participate if they were(More)
Computerized physician order entry (CPOE) has been shown to improve quality, and to reduce resource utilization, but most available data suggest that it takes longer to enter orders using CPOE. We had previously implemented a CPOE system, and elected to evaluate its impact on physician time in the new setting. To do this, we performed a prospective study(More)
OBJECTIVE Detecting adverse events is pivotal for measuring and improving medical safety, yet current techniques discourage routine screening. The authors hypothesized that discharge summaries would include information on adverse events, and they developed and evaluated an electronic method for screening medical discharge summaries for adverse events. (More)
A 53-year-old woman presented for a prescription refill of hydrocodone/acetaminophen 10 mg/325 mg. She had chronic low back pain and partial paralysis from a thoracic spinal cord infarction, secondary to aortic dissection fromprior cocaine use. Taking 2 to 3 tablets ofhydrocodone/acetaminophendaily improvedherbackpain from5to2ona10-point scale. She reported(More)