Schreiber Richard, Gregoire Julia A, Shaha Jacob E, Shaha Steven H
Clinical Informatics, Chief Medical Informatics Officer, Holy Spirit Hospital-A Geisinger Affiliate, 431 North 21st Street, Suite 101, Camp Hill, PA 17011, United States.
Medication Information Systems Manager, Holy Spirit Hospital-A Geisinger Affiliate, 503 North 21st Street, Camp Hill, PA 17011, United States.
Int J Med Inform. 2017 Jan;97:59-67. doi: 10.1016/j.ijmedinf.2016.09.011. Epub 2016 Sep 24.
Pharmacologic interaction alerting offers the potential for safer medication prescribing, but research reveals persistent concerns regarding alert fatigue. Research studies have tried various strategies to resolve this problem, with low overall success. We examined the effects of targeted alert reduction on clinician behavior in a resource constrained hospital.
A physician and a pharmacy informaticist reduced alert levels of several drug-drug interactions (DDI) that clinicians almost always overrode with approval from and knowledge of the medical staff. This study evaluated the behavioral changes in prescribers and non-prescribers as measured by "think time", a new metric for evaluating the resolution time for an alert, before and after suppression of selected DDI alerts.
The user-seen DDI alert rate decreased from 9.98% of all orders to 9.20% (p=0.0001) with an overall volume reduction of 10.3%. There was no statistical difference in the reduction of cancelled (-10.00%) vs. proceed orders (-11.07%). Think time decreased overall by 0.61s (p<0.0001). Think time unexpectedly increased for cancelled orders 1.00s which while not statistically significant (p=0.28) is generally thought to be clinically noteworthy. For overrides, think time decreased 0.67s which was significant (p<0.0001). Think time lowered for both prescribers and non-prescribers. Targeted specialists had shorter think times initially, which shortened more than non-targeted specialists.
Targeted DDI alert reductions reduce alert burden overall, and increase net efficiency as measured by think time for all prescribers better than for non-prescribers. Think time may increase when cancelling or changing orders in response to DDI alerts vs. a decision to override an alert.
药物相互作用警报有助于实现更安全的药物处方，但研究表明，警报疲劳问题一直存在。研究尝试了各种策略来解决这一问题，但总体成功率较低。我们在一家资源有限的医院中研究了针对性警报减少对临床医生行为的影响。
一名医生和一名药房信息专家降低了几种药物相互作用（DDI）的警报级别，这些警报临床医生几乎总是在获得医务人员批准并知晓的情况下予以忽略。本研究通过“思考时间”评估了在抑制选定的DDI警报前后，开处方者和非开处方者行为的变化，“思考时间”是一种评估警报解决时间的新指标。
用户看到的DDI警报率从所有医嘱的9.98%降至9.20%（p=0.0001），总量减少了10.3%。取消医嘱（-10.00%）与继续医嘱（-11.07%）的减少率无统计学差异。总体思考时间减少了0.61秒（p<0.0001）。取消医嘱的思考时间意外增加了1.00秒，虽然无统计学意义（p=0.28），但通常认为具有临床意义。对于忽略警报的情况，思考时间减少了0.67秒，具有统计学意义（p<0.0001）。开处方者和非开处方者的思考时间均有所缩短。目标专科医生最初的思考时间较短，缩短幅度大于非目标专科医生。
针对性减少DDI警报总体上减轻了警报负担，并提高了净效率，以所有开处方者的思考时间衡量，比非开处方者效果更好。与决定忽略警报相比，响应DDI警报取消或更改医嘱时，思考时间可能会增加。
