Department of Pathology and Immunology, Washington University, St. Louis, MO.
Barnes Jewish Hospital, St. Louis, MO.
Clin Chem. 2019 Sep;65(9):1125-1131. doi: 10.1373/clinchem.2018.300657. Epub 2019 Jul 11.
Clinical decision support alerts for laboratory testing have poor compliance. Once-per-visit alerts, triggered by reorder of a test within the same admission, are highly specific for unnecessary orders and provide a means to study alert compliance.
Once-per-visit alerts for 18 laboratory orderables were analyzed over a 60-month period from September 2012 to October 2016 at a 1200-bed academic medical center. To determine correlates of alert compliance, we compared alerts by test and provider characteristics.
Overall alert compliance was 54.5%. In multivariate regression, compliance correlated with length of stay at time of alert, provider type, previous alerts in a patient visit, test ordered, total alerts experienced by ordering provider, and previous order status.
A diverse set of provider and test characteristics influences compliance with once-per-visit laboratory alerts. Future alerts should incorporate these characteristics into alert design to minimize alert overrides.
临床决策支持实验室检测警报的依从性很差。在同一住院期间重新开单时触发的单次就诊警报对不必要的医嘱具有高度特异性，为研究警报依从性提供了一种手段。
在 2012 年 9 月至 2016 年 10 月的 60 个月期间，在一家拥有 1200 张床位的学术医疗中心，对 18 种实验室检测项目的单次就诊警报进行了分析。为了确定警报依从性的相关因素，我们根据检测和提供者的特征对警报进行了比较。
总体警报依从率为 54.5%。在多变量回归中，依从性与警示时的住院时间、提供者类型、患者就诊时的先前警示、检测项目、开单提供者经历的总警示以及先前的医嘱状态相关。
一系列不同的提供者和检测特征影响着单次就诊实验室警报的依从性。未来的警报应将这些特征纳入警报设计中，以最大限度地减少警报被忽略的情况。
