Patient identification errors continue to pose serious risks to patient safety across healthcare settings. Documented incidents include medication orders intended for one individual being applied to another, surgical procedures performed on the wrong patient and critical treatment decisions made based on an incorrect medical record. Beyond rare but severe events, routine misidentification can result in unnecessary tests, delayed care and breaches of confidentiality. In response to these ongoing risks, national guidance on electronic health record use has been revised to better reflect current evidence and practice. A 2024 update to the Patient Identification component of the Safety Assurance Factors for EHR Resilience (SAFER) Guides places stronger emphasis on technology-enabled safeguards designed to reduce wrong-patient errors during registration, clinical ordering and point-of-care activities.
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Evidence-Informed Revisions to National Guidance
The SAFER Guides were originally released in 2014 to outline best practices for electronic health record safety, with an update issued in 2016. Since 2022, hospitals have been required to assess their alignment with these Guides on an annual basis. The 2024 revision represents the first comprehensive update informed by literature published after 2016.
The update process involved a structured review of research on patient identification in healthcare environments. Searches were conducted in July 2024 across multiple bibliographic databases, identifying nearly 900 unique publications from 2017 onwards. Following screening and citation tracking, 148 papers were retained to inform revisions. Recommendations were then refined, added or removed based on the available evidence and classified under a revised grading framework. Practices are now categorised as required, strong, medium or low depending on regulatory mandates, demonstrated impact on safety outcomes, expert consensus or adoption by high-performing organisations. This process led to strengthened guidance on patient photographs and electronic identification technologies, the introduction of biometric identification and the removal of limits on the number of open patient records.
Biometrics and Electronic Identification at Key Workflow Points
The revised guidance focuses on common failure points in patient identification workflows. During registration, matching errors can lead to duplicate records or incorrect record selection. At order entry, clinicians may choose the wrong patient from electronic lists, particularly when names are similar or interruptions occur. At the bedside, verification of multiple identifiers is required but may be inconsistently applied in practice.
To address these risks, the updated Guide recommends the use of biometric technologies to verify patient identity at registration and, for selected care activities, at the point of care. Biometrics are described as physical characteristics such as fingerprints, vein patterns and facial features that are specific to individuals and relatively stable over time. Their use is presented as increasingly common across sectors and already implemented in some healthcare organisations. Examples include palm vein scanning during registration and facial recognition to support appointment check-in. At the bedside, biometric verification can be combined with other identifiers, for example by requiring a palm vein scan before medication dispensing, ensuring that identification occurs in the presence of the patient.
The guidance also recognises limitations associated with biometric approaches. Legal and regulatory constraints may restrict the collection and use of biometric data. Performance may vary across patient populations, with facial recognition technologies noted as potentially less accurate for black patients. Such variability may hinder equitable access if not carefully addressed. Organisations are therefore encouraged to consider acceptability, accessibility and local context when selecting biometric solutions.
Electronic patient identification using wristbands is also reinforced in the updated Guide. Barcoding, radiofrequency identification or similar approaches are recommended at key inpatient points of care. Barcoding is described as the most extensively studied method, with evidence linking its use to improved compliance with identification requirements and lower rates of wrong-patient errors, including errors related to blood specimen labelling. RFID is noted as less widely adopted but promising in terms of accuracy and efficiency. The guidance highlights the need for ongoing monitoring, as equipment failures or workarounds such as scanning copied wristbands away from the bedside can undermine safety benefits.
Patient Photographs and Removal of Open-Record Limits
To reduce wrong-patient order errors, the revised Guide promotes the collection of patient photographs during registration and their display within the electronic health record. Photographs are presented as an additional visual cue to help clinicians confirm they are working in the correct record. Evidence cited includes simulated clinical environments and large quasi-experimental analyses showing faster recognition and lower likelihood of wrong-patient errors when photographs are available. At the same time, the guidance notes that limitations of this practice remain poorly understood, including the influence of image quality on effectiveness.
A notable change in the 2024 update is the removal of a recommendation to restrict the number of patient records that can be open simultaneously within the electronic health record. Earlier guidance was influenced by expert opinion and observational findings suggesting that multiple open records could increase the risk of selection errors. More recent evidence, including a randomised clinical trial and several quasi-experimental studies, found no association between record limits and wrong-patient error rates. The updated guidance also notes that restrictive configurations can introduce new safety risks, such as clinicians resorting to unsafe workarounds or expressing dissatisfaction linked to inefficiency. On this basis, limits on concurrently open records are no longer recommended.
The 2024 revision of the Patient Identification SAFER Guide reflects advances in evidence and technology while addressing persistent risks associated with electronic health record use. By strengthening recommendations on biometrics, electronic identification and patient photographs and by removing unsupported constraints on record access, the updated guidance aims to reduce wrong-patient errors across key clinical workflows. For healthcare professionals and decision-makers, the revisions underscore the importance of combining technology adoption with thoughtful workflow design, performance monitoring and attention to equity and usability to support safer patient identification practices.
Source: JAMIA Open
Image Credit: iStock
