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What’s New in the Patient Safety World

March 2021

ECRI Partnership Whitepaper on Alert Fatigue

 

 

All would agree that alerts generated by clinical decision support systems are valuable patient safety tools. But we’ve all seen how alerts can be obtrusive and interfere with clinician workflow, thus giving rise to “alert fatigue” in which alerts are simply ignored or overridden.

 

ECRI's Partnership for Health IT Patient Safety is a multi-stakeholder collaborative that sets priorities in health IT safety. You’ll recall we highlighted its previous work on “closing the loop” (see our September 2018 What's New in the Patient Safety World column “ECRI Institute Partnership: Closing the Loop”), which focused on improving communication to prevent things from “slipping through the cracks”.

 

The Partnership has now concluded efforts of a similar workgroup focused on finding ways to reduce alert fatigue associated with Computerized Physician Order Entry (CPOE) systems. Recommendations are included in their report “Safe Practices to Reduce CPOE Alert Fatigue through Monitoring, Analysis, and Optimization” (ECRI 2021). The workgroup makes four main safe practice recommendations:

The report reiterates the “5 Rights” model of clinical decision support (CDS) adopted from Osheroff et al. (Osheroff 2012):

  1. The right information: evidence-based, suitable to guide action, pertinent to the circumstance
  2. To the right person: considering all members of the care team, including clinicians, patients, and their caregivers
  3. In the right CDS intervention format: such as an alert, order set, or reference information to answer a clinical question
  4. Through the right channel: for example, a clinical information system such as an electronic medical record, personal health record, or a more general channel such as the internet or a mobile device
  5. At the right time in workflow: for example, at time of decision, action, or need

When we did our first CPOE implementation back in 2007, we were flooded with suggestions for potential alerts that could be used for patient safety. But we readily recognized the need to limit such alerts in order to avoid alert fatigue. We set up a multidisciplinary committee to assess all suggested alerts and to monitor at specified intervals both the impact of such alerts and any unintended consequences. Monitoring included documentation of how often alerts triggered and what the acceptance and override rates were. In addition, clinicians were interviewed to assess their impression of both the utility and the degree of obtrusiveness of any alerts.

 

The Partnership report provides excellent guidance in identifying alert metrics, asking the following key questions:

The report stresses, in initiating optimization efforts, that it is important to ask the following questions:

We’d like to emphasize that last point. In our March 3, 2009 Patient Safety Tip of the Week “Overriding Alerts…Like Surfin’ the Web” we noted that use of standardized order sets may avoid the need to generate some alerts (though standardized order sets can create some problems of the own, particularly when they contain outdated information that is no longer appropriate).

 

We refer you to the full Partnership report for details on all their recommendations. This is an excellent resource that every organization using any form of clinical decision support tools needs to review and incorporate their recommendations into their own programs.

 

 

See some of our other Patient Safety Tip of the Week columns dealing with unintended consequences of technology and other healthcare IT issues:

 

References:

 

 

Partnership for Health IT Patient Safety. Safe Practices to Reduce CPOE Alert Fatigue through Monitoring, Analysis, and Optimization. ECRI 2021

https://d84vr99712pyz.cloudfront.net/p/pdf/hit-partnership/partnership_whitepaper_alertfatigue_final.pdf

(ECRI 2021)

 

 

 

Osheroff JA, Teich JM, Levick D, et al. Improving outcomes with clinical decision support: an implementer’s guide. 2nd ed. Chicago (IL): Healthcare Information and Management Systems Society; 2012

https://www.amazon.com/Improving-Outcomes-Clinical-Decision-Support/dp/0984457739/ref=sr_1_1?dchild=1&keywords=Osheroff&qid=1614095482&s=books&sr=1-1

 

 

 

 

 

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