Department of Informatics, University of California, Irvine, Irvine, California, USA.
J Am Med Inform Assoc. 2019 Oct 1;26(10):1141-1149. doi: 10.1093/jamia/ocz095.
Alert fatigue limits the effectiveness of medication safety alerts, a type of computerized clinical decision support (CDS). Researchers have suggested alternative interactive designs, as well as tailoring alerts to clinical roles. As examples, alerts may be tiered to convey risk, and certain alerts may be sent to pharmacists. We aimed to evaluate which variants elicit less alert fatigue.
We searched for articles published between 2007 and 2017 using the PubMed, Embase, CINAHL, and Cochrane databases. We included articles documenting peer-reviewed empirical research that described the interactive design of a CDS system, to which clinical role it was presented, and how often prescribers accepted the resultant advice. Next, we compared the acceptance rates of conventional CDS-presenting prescribers with interruptive modal dialogs (ie, "pop-ups")-with alternative designs, such as role-tailored alerts.
Of 1011 articles returned by the search, we included 39. We found different methods for measuring acceptance rates; these produced incomparable results. The most common type of CDS-in which modals interrupted prescribers-was accepted the least often. Tiering by risk, providing shortcuts for common corrections, requiring a reason to override, and tailoring CDS to match the roles of pharmacists and prescribers were the most common alternatives. Only 1 alternative appeared to increase prescriber acceptance: role tailoring. Possible reasons include the importance of etiquette in delivering advice, the cognitive benefits of delegation, and the difficulties of computing "relevance."
Alert fatigue may be mitigated by redesigning the interactive behavior of CDS and tailoring CDS to clinical roles. Further research is needed to develop alternative designs, and to standardize measurement methods to enable meta-analyses.
警示疲劳限制了药物安全警示（一种计算机化临床决策支持[CDS]）的有效性。研究人员提出了替代的交互设计方法，并将警示与临床角色相匹配。例如，可以对警示进行分层以传达风险，并且可以将某些警示发送给药剂师。我们旨在评估哪种变体可减少警示疲劳。
我们使用 PubMed、Embase、CINAHL 和 Cochrane 数据库，搜索了 2007 年至 2017 年期间发表的文章。我们纳入了记录 CDS 系统交互设计的同行评审实证研究的文章，这些文章描述了向其展示的临床角色以及临床医生接受由此产生的建议的频率。然后，我们比较了传统的 CDS 呈现给临床医生与中断模态对话框（即“弹出窗口”）的接受率，以及替代设计，例如角色定制的警示。
在搜索返回的 1011 篇文章中，我们纳入了 39 篇。我们发现了不同的方法来衡量接受率；这些结果不可比。最常见的 CDS 类型是模态中断临床医生的类型，其接受率最低。通过风险分层、为常见更正提供快捷方式、要求提供理由来覆盖以及将 CDS 与药剂师和临床医生的角色相匹配，是最常见的替代方法。只有一种替代方法似乎可以增加临床医生的接受率：角色定制。可能的原因包括提供建议时的礼仪重要性、委托的认知益处以及计算“相关性”的困难。
通过重新设计 CDS 的交互行为并根据临床角色定制 CDS，可以减轻警示疲劳。需要进一步研究来开发替代设计，并标准化测量方法以实现荟萃分析。
