Until recently, I didn’t take the problem of clinical decision alert fatigue that seriously, or at least not as seriously as I should have. After all, it’s just an alert, right? You can just shut it off if you don’t like hearing it. Or so it seemed to me, admittedly a naïve pundit from the peanut gallery who’s never treated a patient in her life.
But despite my ignorance, researchers have continued to unearth evidence that alert fatigue may be one of the worst safety hazards afflicting medicine today. After all, this fatigue comes from a deadly one-two punch: the excess noises camouflage the alerts clinicians really need to hear while distracting them from what they’re doing with useless sounds. (If you put me in a situation like that I’d get booted out the door for throwing particularly noisy devices out the window.)
Sadly, alert fatigue is far more than a nuisance. The latest evidence to this effect comes from the Journal of the American Medical Informatics Association, where an article published last month underscored how often alerts cause clinicians to ignore important information.
To conduct their study, a group of researchers conducted a cross-sectional study of medication-related clinical decision support alerts. They collected data at a 793-bed tertiary-care teaching institution, measuring the rate of alert overrides, the reasons cited for overrides and the appropriateness of those reasons.
The results of their analysis were disquieting. On the one hand, they found that roughly 60% of overrides were appropriate overall. In particular, 98% of duplicate drug overrides, 96.5% of patient allergy overrides and 82.5% of formulary substitution overrides were appropriate. That’s the good news. On the other hand, they concluded that 40% of physician alert overrides were inappropriate.
All told, overrides of alerts in certain categories were inappropriate greater than 75% of the time. Let’s take a moment to think about that. Seventy. Five. Percent. Now, I know that “inappropriate” doesn’t mean that the patient would’ve died if the error was corrected, or even that they incur serious harm, but this still isn’t great to hear.
Not surprisingly, researchers said that future studies should optimize alert types and frequencies to improve their clinical relevance so clinicians don’t slap them down over and over like a snooze alarm.
The truth is, studies have been drawing this conclusion for quite some time now, and from what I can see little has changed here.
My assumption is that vendors keep doing what they do because nobody has pressured them enough to make them rethink their CDS logic and drop needless alarms. I’m also guessing that some misinformed health leaders might be reassured by the sound of alerts going on and equating it with higher safety ratings. If so, let’s hope they get disabused of this notion soon.