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  1 / 12 MEDLINE  
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PMID:29419666
Autor:Oh TK; Park YM; Do SH; Hwang JW; Jo YH; Kim JH; Jeon YT; Song IA
Dirección:Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital.
Título:A comparative study of the incidence of in-hospital cardiopulmonary resuscitation on Monday-Wednesday and Thursday-Sunday: Retrospective analysis in a tertiary care hospital.
Fuente:Medicine (Baltimore); 97(6):e9741, 2018 Feb.
ISSN:1536-5964
País de publicación:United States
Idioma:eng
Resumen:Because most medical staff work from Monday-Friday, it is possible that they are relatively more fatigued and less capable of providing emergency supportive services on Thursday-Sunday (Thu-Sun) than on Monday-Wednesday (Mon-Wed). In this study, we aimed to analyze the incidence of in-hospital cardiopulmonary resuscitation (CPR) to determine if it differed between Thu-Sun and Mon-Wed.This retrospective observational study of in-hospital CPR was performed during 2012 to 2016 among inpatients at the Seoul National University Bundang Hospital. The primary outcome was the incidence of in-hospital CPR per 1000 inpatients in the Mon-Wed and Thu-Sun periods. Secondary outcomes included differences in the CPR incidence by time of day and season.In the study, 1195 cases of in-hospital CPR were included. The incidence of in-hospital CPR per 1000 inpatients was significantly higher on Thu-Sun (mean: 0.595, 95% confidence interval [CI]: 0.564-0.626) than on Mon-Wed (mean: 0.505, 95% CI: 0.474-0.536, P < .001). There were no seasonal variations in the incidence of in-hospital CPR. However, in-hospital CPR was most frequently performed between 16:00 and 24:00, and the return of spontaneous circulation (ROSC) rate was the lowest among cases that occurred between 0:00 and 8:00. In addition, the ROSC rate was lowest among female patients, patients with cardiac arrest, and after in-hospital CPR performed on a Sunday.The incidence of in-hospital CPR per 1000 inpatients was significantly higher on Thu-Sun than on Mon-Wed. No seasonal variations were observed in the incidence of in-hospital CPR, but the data suggest circadian variations and differences in ROSC rates.
Tipo de publicación:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY


  2 / 12 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


  3 / 12 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


  4 / 12 MEDLINE  
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PMID:27834782
Autor:McClure C; Jang SY; Fairchild K
Título:Alarms, oxygen saturations, and SpO2 averaging time in the NICU.
Fuente:J Neonatal Perinatal Med; 9(4):357-362, 2016.
ISSN:1878-4429
País de publicación:Netherlands
Idioma:eng
Resumen:BACKGROUND: Alarm overload is a significant concern in the Neonatal Intensive Care Unit (NICU). Selecting a longer oxygen saturation (SpO2) averaging time will reduce the number of alarms but may mask fluctuations in oxygenation. OBJECTIVE: Characterize bedside monitor alarms in the NICU and estimate the impact of longer SpO2 averaging time and alarm delay. METHODS: All bedside monitor alarms were analyzed over a 12-month period in the University of Virginia NICU, using the default averaging time (8 seconds) and SpO2 alarm limits set at 88-95% for infants on supplemental oxygen. In 10 VLBW infants, SpO2 averaging time was lowered to 2 seconds for 24 hours and events of SpO2 out of the target range were estimated with 2-, 8-, or 16-second averaging time, with and without a 15-second alarm delay. RESULTS: There were 3,263,590 alarms in the unit over 12 months. Low or high SpO2 alarms constituted 79% of the total, and 55% of these events lasted <15 seconds. In 10 infants we estimated that increasing SpO2 averaging time from 2 to 16 seconds would have led to 53% fewer SpO2 alarms but the mean duration of alarms would have been 2.15-fold longer. Adding a 15-second alarm delay to 2-second SpO2 averaging in this analysis decreased SpO2 alarms by 67%. CONCLUSION: Longer SpO2 averaging times mask the number and severity of events of aberrant oxygenation in preterm infants without decreasing total alarm time. Incorporating an alarm delay with shorter SpO2 averaging times can reduce alarm number and duration, and allow more accurate assessment of oxygenation, which may be important for research into consequences of aberrant oxygenation in this vulnerable population.
Tipo de publicación:JOURNAL ARTICLE


  5 / 12 MEDLINE  
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PMID:27520600
Autor:Simpson KR; Lyndon A; Davidson LA
Título:Patient Safety Implications of Electronic Alerts and Alarms of Maternal - Fetal Status During Labor.
Fuente:Nurs Womens Health; 20(4):358-66, 2016 Aug-Sep.
ISSN:1751-486X
País de publicación:United States
Idioma:eng
Resumen:When nurses care for women during labor, they encounter numerous alerts and alarms from electronic fetal monitors and their surveillance systems. Notifications of values of physiologic parameters for a woman and fetus that may be outside preset limits are generated via visual and audible cues. There is no standardization of these alert and alarm parameters among electronic fetal monitoring vendors in the United States, and there are no data supporting their sensitivity and specificity. Agreement among professional organizations about physiologic parameters for alerts and alarms commonly used during labor is lacking. It is unknown if labor nurses view the alerts and alarms as helpful or a nuisance. There is no evidence that they promote or hinder patient safety. This clinical issue warrants our attention as labor nurses.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  6 / 12 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


  7 / 12 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


  8 / 12 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


  9 / 12 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


  10 / 12 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



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