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  1 / 9 MEDLINE  
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PMID:28395667
Autor:Ancker JS; Edwards A; Nosal S; Hauser D; Mauer E; Kaushal R; with the HITEC Investigators
Dirección:Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA. jsa7002@med.cornell.edu.
Título:Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
Fuente:BMC Med Inform Decis Mak; 17(1):36, 2017 Apr 10.
ISSN:1472-6947
País de publicación:England
Idioma:eng
Resumen:BACKGROUND: Although alert fatigue is blamed for high override rates in contemporary clinical decision support systems, the concept of alert fatigue is poorly defined. We tested hypotheses arising from two possible alert fatigue mechanisms: (A) cognitive overload associated with amount of work, complexity of work, and effort distinguishing informative from uninformative alerts, and (B) desensitization from repeated exposure to the same alert over time. METHODS: Retrospective cohort study using electronic health record data (both drug alerts and clinical practice reminders) from January 2010 through June 2013 from 112 ambulatory primary care clinicians. The cognitive overload hypotheses were that alert acceptance would be lower with higher workload (number of encounters, number of patients), higher work complexity (patient comorbidity, alerts per encounter), and more alerts low in informational value (repeated alerts for the same patient in the same year). The desensitization hypothesis was that, for newly deployed alerts, acceptance rates would decline after an initial peak. RESULTS: On average, one-quarter of drug alerts received by a primary care clinician, and one-third of clinical reminders, were repeats for the same patient within the same year. Alert acceptance was associated with work complexity and repeated alerts, but not with the amount of work. Likelihood of reminder acceptance dropped by 30% for each additional reminder received per encounter, and by 10% for each five percentage point increase in proportion of repeated reminders. The newly deployed reminders did not show a pattern of declining response rates over time, which would have been consistent with desensitization. Interestingly, nurse practitioners were 4 times as likely to accept drug alerts as physicians. CONCLUSIONS: Clinicians became less likely to accept alerts as they received more of them, particularly more repeated alerts. There was no evidence of an effect of workload per se, or of desensitization over time for a newly deployed alert. Reducing within-patient repeats may be a promising target for reducing alert overrides and alert fatigue.
Tipo de publicación:JOURNAL ARTICLE


  2 / 9 MEDLINE  
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PMID:27897445
Autor:Ip IK; Lacson R; Hentel K; Malhotra S; Darer J; Langlotz C; Weiss J; Raja AS; Khorasani R
Dirección:1 Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St, 2nd Fl, Brookline, MA 02445.
Título:JOURNAL CLUB: Predictors of Provider Response to Clinical Decision Support: Lessons Learned From the Medicare Imaging Demonstration.
Fuente:AJR Am J Roentgenol; 208(2):351-357, 2017 Feb.
ISSN:1546-3141
País de publicación:United States
Idioma:eng
Resumen:OBJECTIVE: The efficacy of imaging clinical decision support (CDS) varies. Our objective was to identify CDS factors contributing to imaging order cancellation or modification. SUBJECTS AND METHODS: This pre-post study was performed across four institutions participating in the Medicare Imaging Demonstration. The intervention was CDS at order entry for selected outpatient imaging procedures. On the basis of the information entered, computerized alerts indicated to providers whether orders were not covered by guidelines, appropriate, of uncertain appropriateness, or inappropriate according to professional society guidelines. Ordering providers could override or accept CDS. We considered actionable alerts to be those that could generate an immediate order behavior change in the ordering physician (i.e., cancellation of inappropriate orders or modification of orders of uncertain appropriateness that had a recommended alternative). Chi-square and logistic regression identified predictors of order cancellation or modification after an alert. RESULTS: A total of 98,894 radiology orders were entered (83,114 after the intervention). Providers ignored 98.9%, modified 1.1%, and cancelled 0.03% of orders in response to alerts. Actionable alerts had a 10 fold higher rate of modification (8.1% vs 0.7%; p < 0.0001) or cancellation (0.2% vs 0.02%; p < 0.0001) orders compared with nonactionable alerts. Orders from institutions with preexisting imaging CDS had a sevenfold lower rate of cancellation or modification than was seen at sites with newly implemented CDS (1.4% vs 0.2%; p < 0.0001). In multivariate analysis, actionable alerts were 12 times more likely to result in order cancellation or modification. Orders at sites with preexisting CDS were 7.7 times less likely to be cancelled or modified (p < 0.0001). CONCLUSION: Using results from the Medicare Imaging Demonstration project, we identified potential factors that were associated with CDS effect on provider imaging ordering; these findings may have implications for future design of such computerized systems.
Tipo de publicación:JOURNAL ARTICLE; MULTICENTER STUDY


  3 / 9 MEDLINE  
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PMID:27045070
Autor:Tilson H; Hines LE; McEvoy G; Weinstein DM; Hansten PD; Matuszewski K; le Comte M; Higby-Baker S; Hanlon JT; Pezzullo L; Vieson K; Helwig AL; Huang SM; Perre A; Bates DW; Poikonen J; Wittie MA; Grizzle AJ; Brown M; Malone DC
Dirección:Public Health Leadership and Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC.
Título:Recommendations for selecting drug-drug interactions for clinical decision support.
Fuente:Am J Health Syst Pharm; 73(8):576-85, 2016 Apr 15.
ISSN:1535-2900
País de publicación:United States
Idioma:eng
Resumen:PURPOSE: Recommendations for including drug-drug interactions (DDIs) in clinical decision support (CDS) are presented. SUMMARY: A conference series was conducted to improve CDS for DDIs. A work group consisting of 20 experts in pharmacology, drug information, and CDS from academia, government agencies, health information vendors, and healthcare organizations was convened to address (1) the process to use for developing and maintaining a standard set of DDIs, (2) the information that should be included in a knowledge base of standard DDIs, (3) whether a list of contraindicated drug pairs can or should be established, and (4) how to more intelligently filter DDI alerts. We recommend a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization. We outline key DDI information needed to help guide clinician decision-making. We recommend judicious classification of DDIs as contraindicated and more research to identify methods to safely reduce repetitive and less-relevant alerts. CONCLUSION: An expert panel with a centralized organizer or convener should be established to develop and maintain a standard set of DDIs for CDS in the United States. The process should be evidence driven, transparent, and systematic, with feedback from multiple stakeholders for continuous improvement. The scope of the expert panel's work should be carefully managed to ensure that the process is sustainable. Support for research to improve DDI alerting in the future is also needed. Adoption of these steps may lead to consistent and clinically relevant content for interruptive DDIs, thus reducing alert fatigue and improving patient safety.
Tipo de publicación:JOURNAL ARTICLE


  4 / 9 MEDLINE  
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PMID:27045062
Autor:Brodowy B; Nguyen D
Dirección:Medication Outcomes CenterUniversity of California, San FranciscoSan Francisco, CAbret.brodowy@ucsf.edu.
Título:Optimization of clinical decision support through minimization of excessive drug allergy alerts.
Fuente:Am J Health Syst Pharm; 73(8):526-8, 2016 Apr 15.
ISSN:1535-2900
País de publicación:United States
Idioma:eng
Tipo de publicación:JOURNAL ARTICLE


  5 / 9 MEDLINE  
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PMID:27045060
Autor:Glassman PA; Good CB; Cunningham FE
Dirección:Department of MedicineVeterans Affairs Greater Los Angeles Healthcare SystemLos Angeles, CADavid Geffen School of MedicineUniversity of California at Los AngelesLos Angeles, CA.
Título:Drug alerts and the Goldilocks principle: Striving for "just right".
Fuente:Am J Health Syst Pharm; 73(8):517, 2016 Apr 15.
ISSN:1535-2900
País de publicación:United States
Idioma:eng
Tipo de publicación:EDITORIAL


  6 / 9 MEDLINE  
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PMID:26107794
Autor:Footracer KG
Dirección:Katherine G. Footracer practices at Lakeside Community Healthcare in Glendale, Calif. The author has disclosed no potential conflicts of interest, financial or otherwise.
Título:Alert fatigue in electronic health records.
Fuente:JAAPA; 28(7):41-2, 2015 Jul.
ISSN:1547-1896
País de publicación:United States
Idioma:eng
Resumen:Electronic health records (EHRs) are changing the practice of medicine. EHRs offer potential benefits but also potential problems and threats to patient safety, especially in the area of electronic prescribing.
Tipo de publicación:JOURNAL ARTICLE


  7 / 9 MEDLINE  
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PMID:25849772
Autor:Bailey JM
Dirección:a Information Technology Services, Northeast Georgia Health System , Gainesville , GA 30501 , USA.
Título:The implications of probability matching for clinician response to vital sign alarms: a theoretical study of alarm fatigue.
Fuente:Ergonomics; 58(9):1487-95, 2015.
ISSN:1366-5847
País de publicación:England
Idioma:eng
Resumen:Alarm fatigue has been recognised as a significant health technology safety risk. 'Probability matching', in which clinicians respond to the alarm at a rate identical to the perceived reliability of the alarm, has been postulated as a model to explain alarm fatigue. In this article, we quantitatively explore the implications of probability matching for systolic blood pressure alarms. We find that probability matching could have a profound effect on clinician response to the alarm, with a response rate of only 8.6% when the alarm threshold is 90 mm Hg and the optimal threshold for a systolic blood pressure alarm would only be 77 mm Hg. We use the mathematical framework to assess a mitigation strategy when clinicians have a limit to the capacity to respond. We find that a tiered alarm in which clinicians receive information on the severity of vital sign perturbation significantly improves the opportunity to rescue patients. Practitioner Summary: Using a theoretical model, we predict that probability matching, a postulated model of clinician behaviour, can result in a profound decrease in clinician response to alarms for decreased blood pressure. A mitigating strategy is to create alarms that convey information on the degree of vital sign perturbation.
Tipo de publicación:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T


  8 / 9 MEDLINE  
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PMID:25840128
Autor:Walsh-Irwin C; Jurgens CY
Dirección:Colleen Walsh-Irwin, DNP, RN, ANP, CCRN, is the cardiovascular clinical nurse advisor for the Department of Veterans Affairs, Northport, New York. She is a clinical assistant professor at Stony Brook University School of Nursing. Dr Walsh-Irwin has an extensive cardiac nursing background and currently works as a cardiology nurse practitioner. Corrine Y. Jurgens, PhD, RN, ANP-BC, FAHA, FAAN, is a tenured associate professor and director of Cardiovascular Nursing Research in the School of Nursing at Stony Brook University. Her research has been supported by the American Heart Association (AHA), the Hartford Foundation and Stony Brook University School of Nursing. She was inducted as a fellow of the American Academy of Nursing in 2014. Dr Jurgens is an active member of the AHA and Heart Failure Society of America (HFSA). She is a fellow of both the AHA Cardiovascular Nursing Council and the Quality of Care and Outcomes Research Council. Dr Jurgens also sits on the HFSA executive council. She reviews for several research journals and is on the editorial board for the Journal of Cardiovascular Nursing. Dr Jurgens has a clinical background in critical care and cardiovascular nursing.
Título:Proper skin preparation and electrode placement decreases alarms on a telemetry unit.
Fuente:Dimens Crit Care Nurs; 34(3):134-9, 2015 May-Jun.
ISSN:1538-8646
País de publicación:United States
Idioma:eng
Resumen:BACKGROUND: An estimated 85% to 99% of electrocardiographic (ECG) alarms are false, leading to alarm fatigue, which is associated with increased risk of death among hospitalized patients. OBJECTIVE: The aim of this study was to examine the effect of proper skin preparation and electrode placement on frequency of ECG alarms on a telemetry unit. METHOD: A prospective descriptive design was used to test the effect of proper skin preparation and ECG electrode placement. Purposive sampling of patients (n = 15) admitted to a telemetry hospital in a suburban Veterans Affairs Medical Center was used. Alarms were counted for 24 hours after admission, electrodes were replaced using proper technique, and alarms were counted for 24 hours after electrode change. Bootstrapping was used to double the sample size for analysis. RESULTS: Electrocardiographic alarms decreased significantly (P < .05) after proper skin preparation and electrode placement (95% confidence interval, 1.273-82.327). DISCUSSION: Proper skin preparation and ECG electrode placement reduced alarms. Reducing alarm frequency is vital to decreasing alarm fatigue and increasing patient safety.
Tipo de publicación:JOURNAL ARTICLE


  9 / 9 MEDLINE  
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PMID:25591100
Autor:Bridi AC; Louro TQ; da Silva RC
Dirección:Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Título:Clinical Alarms in intensive care: implications of alarm fatigue for the safety of patients.
Fuente:Rev Lat Am Enfermagem; 22(6):1034-40, 2014 Nov-Dec.
ISSN:1518-8345
País de publicación:Brazil
Idioma:eng; por; spa
Resumen:OBJECTIVES: to identify the number of electro-medical pieces of equipment in a coronary care unit, characterize their types, and analyze implications for the safety of patients from the perspective of alarm fatigue. METHOD: this quantitative, observational, descriptive, non-participatory study was conducted in a coronary care unit of a cardiology hospital with 170 beds. RESULTS: a total of 426 alarms were recorded in 40 hours of observation: 227 were triggered by multi-parametric monitors and 199 were triggered by other equipment (infusion pumps, dialysis pumps, mechanical ventilators, and intra-aortic balloons); that is an average of 10.6 alarms per hour. CONCLUSION: the results reinforce the importance of properly configuring physiological variables, the volume and parameters of alarms of multi-parametric monitors within the routine of intensive care units. The alarms of equipment intended to protect patients have increased noise within the unit, the level of distraction and interruptions in the workflow, leading to a false sense of security.
Tipo de publicación:JOURNAL ARTICLE; OBSERVATIONAL STUDY



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