Alert Fatigue in Healthcare
The constant beep and buzz of mobile alerts has become part of daily life, but for healthcare professionals alert fatigue is presenting a serious problem. The implementation of electronic health records (EHRs) includes automated alerts related to patient information. This is resulting in bombardment with notifications, such as alerts that a new drug being prescribed might not interact well with the patient’s other medications, or a reminder that the patient has a particular drug allergy.
Notifications are Overwhelming
While the philosophy behind these alerts is all good, the number has become unmanageable. Many are safety notifications based on broad-brush, excessive caution, and statistics show they are being ignored up to 96% of the time. After several incidents of potentially lethal outcomes, healthcare professionals have become aware of the risks posed by the tsunami of alerts, and are looking for a way to reduce the deluge.
Improving Alert Logic
Various methods are being explored in an effort to stem the flow. Software companies are working on improving alert logic through the use of data, to make warnings more targeted and relevant. Some medical institutions are demanding greater user control over the configuration of their systems, and the ability to turn off what they consider excessive alerts. Whether controls are positioned at organizational level, departmental level or end-user level depends on understanding that healthcare environments differ from each other. This means the priorities and relevance of notifications also differ, according to the setting.
Possible adjustments for reducing the number of distractions, and making those that get through more relevant, include:
1) Changing the system so medication alerts for patients are sent only to the primary care doctor, not every person involved with their care. This would allow pressing notifications to get the attention they need. For a patient at risk for sepsis, for example, an alert requires quicker action than one notifying a pharmacist of a potential minor interaction with a new drug.
2) Using unique design strategies to present categories of alerts differently. This will enable recipients to identify the relative importance of the alert at a glance, without having to open every notification that comes in. These could use contextual or tiered mechanisms based on patient data, such as age, gender, weight, cardiac function levels and others.
3) Implementing “human factor” engineering by paying deep attention to the end-user experience. This is used successfully in aviation, where cockpit technology is designed to transmit only critical alerts to pilots. This reduces the number of minor alerts and enables recipients to maintain high situational awareness.
4) Conducting ongoing research, maintenance and updating of clinical material and notification content, to ensure healthcare professionals get only the latest and most current information at the point of care. Alerts based on outdated information, even if it’s only a few hours old, can mean the difference between life and death.
With medical errors the third leading cause of death in the U.S. with a quarter-million victims each year, and more than 500 New Zealand patients having had healthcare “failures” during 2015, it’s obvious the need is great for methods that improve safety. The introduction of clinical decision support (CDS) tools has the potential to significantly reduce errors, particularly drug-related ones such as dosing mistakes, drug interactions, duplications or allergies.
Finding ways to reduce alert fatigue is vital if healthcare professionals and their patients are to benefit from multiple ways mobile technology can help to transfer data. Just as you can take a horse to water but you can’t make it drink, delivering notifications to doctors is valuable only if they are likely to read and act on them.
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