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Appl Clin Inform 2024; 15(01): 101-110
DOI: 10.1055/a-2226-8144
Research Article

Addressing Alert Fatigue by Replacing a Burdensome Interruptive Alert with Passive Clinical Decision Support

Anne Fallon
1   Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, United States
,
Kristina Haralambides
2   Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, United States
,
Justin Mazzillo
3   Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, United States
,
Conrad Gleber
4   Division of Hospital Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, New York, United States
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Abstract

Background Recognizing that alert fatigue poses risks to patient safety and clinician wellness, there is a growing emphasis on evaluation and governance of electronic health record clinical decision support (CDS). This is particularly critical for interruptive alerts to ensure that they achieve desired clinical outcomes while minimizing the burden on clinicians. This study describes an improvement effort to address a problematic interruptive alert intended to notify clinicians about patients needing coronavirus disease 2019 (COVID) precautions and how we collaborated with operational leaders to develop an alternative passive CDS system in acute care areas.

Objectives Our dual aim was to reduce the alert burden by redesigning the CDS to adhere to best practices for decision support while also improving the percent of admitted patients with symptoms of possible COVID who had appropriate and timely infection precautions orders.

Methods Iterative changes to CDS design included adjustment to alert triggers and acknowledgment reasons and development of a noninterruptive rule-based order panel for acute care areas. Data on alert burden and appropriate precautions orders on symptomatic admitted patients were followed over time on run and attribute (p) and individuals-moving range control charts.

Results At baseline, the COVID alert fired on average 8,206 times per week with an alert per encounter rate of 0.36. After our interventions, the alerts per week decreased to 1,449 and alerts per encounter to 0.07 equating to an 80% reduction for both metrics. Concurrently, the percentage of symptomatic admitted patients with COVID precautions ordered increased from 23 to 61% with a reduction in the mean time between COVID test and precautions orders from 19.7 to −1.3 minutes.

Conclusion CDS governance, partnering with operational stakeholders, and iterative design led to successful replacement of a frequently firing interruptive alert with less burdensome passive CDS that improved timely ordering of COVID precautions.

Keywords

clinical decision support systems - alert fatigue - patient safety - clinical governance

Protection of Human and Animal Subjects

This project was deemed exempt as non-Human Subject Research per our Institutional Review Board. Following query validation, no protected health information was accessed and only aggregated de-identified data were stored and analyzed on an internal institutional OneDrive compliant with the Health Insurance Portability and Accountability Act (HIPAA).


Supplementary Material



Publication History

Received: 24 September 2023

Accepted: 11 December 2023

Accepted Manuscript online:
12 December 2023

Article published online:
31 January 2024

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