Appropriateness of Alerts and Physicians’ Responses With a Medication-Related Clinical Decision Support System: Retrospective Observational Study

Abstract

Background Alert fatigue is unavoidable when many irrelevant alerts are generated in response to a small number of useful alerts. It is necessary to increase the effectiveness of the clinical decision support system (CDSS) by understanding physicians’ responses. Objective This study aimed to understand the CDSS and physicians’ behavior by evaluating the clinical appropriateness of alerts and the corresponding physicians’ responses in a medication-related passive alert system. Methods Data on medication-related orders, alerts, and patients’ electronic medical records were analyzed. The analyzed data were generated between August 2019 and June 2020 while the patient was in the emergency department. We evaluated the appropriateness of alerts and physicians’ responses for a subset of 382 alert cases and classified them. Results Of the 382 alert cases, only 7.3% (n=28) of the alerts were clinically appropriate. Regarding the appropriateness of the physicians’ responses about the alerts, 92.4% (n=353) were deemed appropriate. In the classification of alerts, only 3.4% (n=13) of alerts were successfully triggered, and 2.1% (n=8) were inappropriate in both alert clinical relevance and physician’s response. In this study, the override rate was 92.9% (n=355). Conclusions We evaluated the appropriateness of alerts and physicians’ responses through a detailed medical record review of the medication-related passive alert system. An excessive number of unnecessary alerts are generated, because the algorithm operates as a rule base without reflecting the individual condition of the patient. It is important to maximize the value of the CDSS by comprehending physicians’ responses.

Physicians' acceptance of drug-drug interaction alerts from clinical decision support systems: A systematic review and meta-analysis

“…After providing evidence-based information and removing minor alerts, a CDSS requires rigorous evaluation to determine the optimal sensitivity and speci city ratio to reduce patient harm. No system can achieve 100% sensitivity and speci city in a real-world setting [39]. Filtering lists of drug interactions in CDSS databases, keeping only clinically signi cant pairs, may improve the "alert fatigue" effect but also create liability concerns for clinicians, who could perceive these systems to be at risk of making mistakes.…”

“…Therefore, about 30% of alerts could be avoided if only ve laboratory test results were integrated into the system, including potassium, white blood cell count, international normalized ratio, therapeutic drug monitoring, and glomerular ltration rate values [36]. Another way to reduce the number of alerts is to direct these alerts based on the specialty of the prescribing physician, for instance, not generating an excessive number of renal risk alerts for a kidney specialist with many years of experience [39]. With this, con dence in these systems tends to increase since physicians ignore alerts because of their lack of speci city; thus, alerts generated for the general population could be changed if the characteristics of patients and physicians were considered [36].…”

Evaluation of appropriateness of alerts overrides and physicians' responses of the medication-related clinical decision support system in China, a hospital-based study

“…Medication-related clinical decision support system (MRCDSS) has become an indispensable component of hospital information system (HIS) (1). It's algorithms commonly include data of clinical characteristics of patients (demographic data, results of laboratory examinations, severity, etc.…”

“…Conversely, only 7.3% of the alerts were clinically appropriate. Too many unnecessary alerts were generated (1). These published findings indicate that the MRCDSS so far is far from satisfactory.…”

Construction and effectiveness evaluation of a knowledge-based infectious disease monitoring and decision support system

“…With respect to the alerting methods used in CDSS applications, Park al. 's research 22 used interruptive alerts in drug interaction warnings, which directly interrupted the clinical physician's workflow with pop-up notifications. Binh et al 23 used list-style alerts to remind clinical physicians to complete preventive care orders.…”