Dexheimer Judith W, Kirkendall Eric S, Kouril Michal, Hagedorn Philip A, Minich Thomas, Duan Leo L, Mahdi Monifa, Szczesniak Rhonda, Spooner S Andrew
Judith Dexheimer, PhD, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, MLC 2008, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, Email:
Appl Clin Inform. 2017 May 10;8(2):491-501. doi: 10.4338/ACI-2016-10-RA-0168.
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.
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.
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.
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.
美国超过70%的医院拥有电子健康记录（EHR）。临床决策支持（CDS）在患者护理过程中为临床医生提供电子警报；然而，警报疲劳会影响医疗人员对任何电子健康记录警报的反应。主要目标是评估警报负担对用户对警报反应的影响。
我们对一家大型儿科学术医疗中心在24个月期间（2013年1月至2014年12月）的用药警报进行了回顾性研究。机构审查委员会批准了这项研究。主要结果指标是警报显著性，即衡量开处方者是否对产生警报的医嘱采取了任何纠正措施。我们估计了使显著性最大化的理想警报数量。通过逻辑回归分析，按培训水平、星期几和一天中的时间对各医疗人员的显著性率进行了检查。
虽然显著性从未超过38%，但在我们的数据集中，每天49次警报与最大显著性相关。下达医嘱的时间与警报显著性相关（凌晨2点时显著性最高）。星期几也与警报显著性相关（星期三显著性最高）。医疗人员的角色对显著性没有影响。
警报负担在影响医疗人员对用药警报的反应方面发挥着作用。医疗人员在一天中看到的警报数量增加并没有直接导致对警报反应的降低。鉴于影响对警报反应的因素众多，仅专注于负担的努力不太可能有效。
