The Effects of Medication Alerts on Prescriber Response in a Pediatric Hospital

Judith W Dexheimer; Eric S. Kirkendall; Michal Kouril; Philip A. Hagedorn; Thomas Minich; Leo L. Duan; Monifa Mahdi; Rhonda Szczesniak; S. Andrew Spooner

doi:10.4338/ACI-2016-10-RA-0168

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2017; 08(02): 491-501
DOI: 10.4338/ACI-2016-10-RA-0168

Research Article

Schattauer GmbH

The Effects of Medication Alerts on Prescriber Response in a Pediatric Hospital

Authors

Judith W Dexheimer

¹Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

²Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Eric S. Kirkendall

²Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

³Department of Information Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

⁴Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

⁵James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Michal Kouril

²Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Philip A. Hagedorn

³Department of Information Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

⁴Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Thomas Minich

³Department of Information Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

⁶Division of Pharmacy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Leo L. Duan

⁷Center for Imaging Research, Johns Hopkins University, Baltimore, MD
Monifa Mahdi

⁴Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Rhonda Szczesniak

⁸Division of Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

⁹Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
S. Andrew Spooner

²Department of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

³Department of Information Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

⁴Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

Abstract

Summary

Objective: More than 70% of hospitals in the United States have electronic health records (EHRs). Clinical decision support (CDS) presents clinicians with electronic alerts during the course of patient care; however, alert fatigue can influence a provider’s response to any EHR alert. The primary goal was to evaluate the effects of alert burden on user response to the alerts.

Methods: We performed a retrospective study of medication alerts over a 24-month period (1/2013–12/2014) in a large pediatric academic medical center. The institutional review board approved this study. The primary outcome measure was alert salience, a measure of whether or not the prescriber took any corrective action on the order that generated an alert. We estimated the ideal number of alerts to maximize salience. Salience rates were examined for providers at each training level, by day of week, and time of day through logistic regressions.

Results: While salience never exceeded 38%, 49 alerts/day were associated with maximal salience in our dataset. The time of day an order was placed was associated with alert salience (maximal salience 2am). The day of the week was also associated with alert salience (maximal salience on Wednesday). Provider role did not have an impact on salience.

Conclusion: Alert burden plays a role in influencing provider response to medication alerts. An increased number of alerts a provider saw during a one-day period did not directly lead to decreased response to alerts. Given the multiple factors influencing the response to alerts, efforts focused solely on burden are not likely to be effective.

Citation: Dexheimer JW, Kirkendall ES, Kouril M, Hagedorn PA, Minich T, Duan LL, Mahdi M, Szczesniak R, Spooner SA. The effects of medication alerts on prescriber response in a pediatric hospital. Appl Clin Inform 2017; 8: 491–501 https://doi.org/10.4338/ACI-2016-10-RA-0168

Keywords

Medical informatics - clinical decision support - inpatient (inpatient CPOE) - electronic health records and systems - alert fatigue - alerting

Full Text

References

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