Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Am Med Inform Assoc. 2018 May 1;25(5):476-481. doi: 10.1093/jamia/ocx115.
To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers' reasons for overriding them and the appropriateness of those reasons.
We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons.
Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P < .0001). About 60% of overrides were appropriate, and that proportion also varied by alert type (P < .0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution (82.5%) alerts were appropriate.
Despite warnings of potential significant harm, certain categories of alert overrides were inappropriate >75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue.
Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.
定义住院临床决策支持警报的类型和数量，衡量其被覆盖的频率，并描述提供者覆盖它们的原因以及这些原因的适当性。
我们在一家 793 张床位的三级教学医院进行了一项为期 3 年的药物相关临床决策支持警报的横断面研究。我们测量了警报覆盖的比率、每种警报类型的覆盖率、覆盖的原因以及这些原因的适当性。
总体而言，73.3%的患者过敏、药物相互作用和重复药物警报被覆盖，尽管覆盖率因警报类型而异（P <.0001）。大约 60%的覆盖是适当的，这一比例也因警报类型而异（P <.0001）。很少有肾（2.2%）或基于年龄（26.4%）的药物替代的覆盖是适当的，而大多数重复药物（98%）、患者过敏（96.5%）和处方替代（82.5%）警报是适当的。
尽管有潜在的严重危害的警告，但某些类别的警报覆盖在超过 75%的时间内是不适当的。绝大多数重复药物、患者过敏和处方替代警报是适当的，这表明这些类别的警报可能是一个很好的目标，可以进行改进以减少警报疲劳。
近四分之三的警报被覆盖，其中 40%的覆盖是不适当的。未来的研究应该优化警报类型和频率，以提高其临床相关性，减少警报疲劳，从而避免不恰当地覆盖重要警报。
