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| − | '''Alert fatigue''' or otherwise known as "pop-up" fatigue is a commonly perceived occurrence with the recent implementation of [[EMR]]s (electronic medical records) and specifically [[CDS]] (decision support)
| + | #REDIRECT[[Alerts]] |
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| − | == Introduction ==
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| − | Given that medical errors receive much press in reality many of the errors are secondary to a provider's difficulty with knowledge management. Clearly, the volume of information an average ambulatory provider must remember is too much. The volume increases daily and in order to keep current a provider needs help. Decision support is one type of help that has evolved. As stated by Dr Eric Rose, "where human brains fail, computers excel."
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| − | One form of tools to aid the provider is alerts. Alerts can be in the form of "pop-ups," contact-dependent (during access of patient's record), and/or contact-independent (alert "delivered" to provider). The alerts, while found to be beneficial in some cases, can result in a type of "fatigue" whereby the provider, after receiving too many alerts, begins to ignore and/or override the alerts. Receiving too many alerts can result in slowing the provider down rendering the alert useless.
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| − | A recent review stated that safety alerts are overridden by clinicians 49-96% of the time (1). For example, in Portland, Oregon the Multnomah County Health Department, which recently implemented an EMR, decided to significantly reduce the number of drug-drug interactions providers were seeing during order entry. The providers felt in order to "get through their daily work," they were forced to override several of the drug-drug interactions.
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| − | Likewise, as studied in ambulatory settings alert overrides were secondary to poor specificity and [[CPOE]]s need to suppress alerts for renewals of medication combinations that patients currently tolerate (2). By changing the severity level of drug-drug interactions Multnomah County Health Department providers have commented positively on the drug-drug interaction alerts. Some suggestions to avoid alert fatigue are alerts should be not overused, not repeated several times a day, alert gives enough time to make a decision, and creating selectively targeted alerts.
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| − | Similarly, Shah NR, et al found, in a 6-month study, that by changing the alert setting to critical/high severity (i.e. high specificity) led to 71% of the alerts being non-interruptive (3). This study and others show the need for the distinction between appropriate and useful alerts. A recent example of a useful alert was the acceptance and highly successful alert of cancelling a medication order when the creatinine clearance of a patient made the medication order not safe (4).
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| − | While studies on the cognitive processes ["fatigue"] playing a role in overriding drug safety alerts are lacking, an in depth analysis of the practice/provider's needs may result in a significant "buy-in" resulting in an effective alert with improved outcomes (1). In summary, overriding of alerts is a common practice, but whether "alert fatigue" is a reality remains to be proven. Future studies to address the cognitive effects may elucidate the root of overrides and possibly reveal the perceived "fatigue."
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| − | Amit Shah, MD [As001]
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| − | == References ==
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| − | # Rose E. "Life after Go-Live, Part 4: Preventing Error in an EMR." Journal of Healthcare Information Management. Vol 17, No.4.
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| − | # Krall M. "Clinicians' Assessments of Outpatient Electronic Medical Alert and Reminder Usability and Usefulness Requirements: A Qualitative Study." May 2002.
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| − | # Heleen van der Sijs, et al. "Overridding of Drug Safety Alerts in Computer Physician Order Entry." J Am Med Inform Assoc. 2006;13:138-147.
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| − | # Weingart, et al. "Physicians' decisions to override computerized drug alerts in Primary Care." Arch Intern Med. 2003 Nov 24;163(21):2625-31.
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| − | # Shah NR, et al. "Improving Acceptance of Computerized Prescribing alerts in Ambulatory Care." J Am Med Inform Assoc. 2006 Jan-Feb;13(1):5-11.
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| − | # Galanter, et al. "A trial of Automated Decision Support Alerts for Contraindicated Medications Using Computerized Physician Order Entry." J Am Med Inform Assoc. 2005; 12:269-274.
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| − | [[Category:OHSU-SP-06]]
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