First name
Philip
Middle name
A
Last name
Hagedorn

Title

Clinical Decision Support Stewardship: Best Practices and Techniques to Monitor and Improve Interruptive Alerts.

Year of Publication

2022

Number of Pages

560-568

Date Published

05/2022

ISSN Number

1869-0327

Abstract

Interruptive clinical decision support systems, both within and outside of electronic health records, are a resource that should be used sparingly and monitored closely. Excessive use of interruptive alerting can quickly lead to alert fatigue and decreased effectiveness and ignoring of alerts. In this review, we discuss the evidence for effective alert stewardship as well as practices and methods we have found useful to assess interruptive alert burden, reduce excessive firings, optimize alert effectiveness, and establish quality governance at our institutions. We also discuss the importance of a holistic view of the alerting ecosystem beyond the electronic health record.

DOI

10.1055/s-0042-1748856

Alternate Title

Appl Clin Inform

PMID

35613913

Title

Alert burden in pediatric hospitals: a cross-sectional analysis of six academic pediatric health systems using novel metrics.

Year of Publication

2021

Date Published

2021 Oct 19

ISSN Number

1527-974X

Abstract

<p><strong>BACKGROUND: </strong>Excessive electronic health record (EHR) alerts reduce the salience of actionable alerts. Little is known about the frequency of interruptive alerts across health systems and how the choice of metric affects which users appear to have the highest alert burden.</p>

<p><strong>OBJECTIVE: </strong>(1) Analyze alert burden by alert type, care setting, provider type, and individual provider across 6 pediatric health systems. (2) Compare alert burden using different metrics.</p>

<p><strong>MATERIALS AND METHODS: </strong>We analyzed interruptive alert firings logged in EHR databases at 6 pediatric health systems from 2016-2019 using 4 metrics: (1) alerts per patient encounter, (2) alerts per inpatient-day, (3) alerts per 100 orders, and (4) alerts per unique clinician days (calendar days with at least 1 EHR log in the system). We assessed intra- and interinstitutional variation and how alert burden rankings differed based on the chosen metric.</p>

<p><strong>RESULTS: </strong>Alert burden varied widely across institutions, ranging from 0.06 to 0.76 firings per encounter, 0.22 to 1.06 firings per inpatient-day, 0.98 to 17.42 per 100 orders, and 0.08 to 3.34 firings per clinician day logged in the EHR. Custom alerts accounted for the greatest burden at all 6 sites. The rank order of institutions by alert burden was similar regardless of which alert burden metric was chosen. Within institutions, the alert burden metric choice substantially affected which provider types and care settings appeared to experience the highest alert burden.</p>

<p><strong>CONCLUSION: </strong>Estimates of the clinical areas with highest alert burden varied substantially by institution and based on the metric used.</p>

DOI

10.1093/jamia/ocab179

Alternate Title

J Am Med Inform Assoc

PMID

34664664

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