patient safety; health information technology; guideline adherence; overriding; venous thromboembolism; medical informatics research; drug-drug interactions; alert fatigue; clinical decision support; computerized physician order entry; non-interruptive reminders
Nanji Karen C, Seger Diane L, Slight Sarah P, Amato Mary G, Beeler Patrick E, Her Qoua L, Dalleur Olivia, Eguale Tewodros, Wong Adrian, Silvers Elizabeth R, Swerdloff Michael, Hussain Salman T, Maniam Nivethietha, Fiskio Julie M, Dykes Patricia C, Bates David W (2017), Medication-related clinical decision support alert overrides in inpatients., in Journal of the American Medical Informatics Association : JAMIA
Wong Adrian, Amato Mary G, Seger Diane L, Slight Sarah P, Beeler Patrick E, Dykes Patricia C, Fiskio Julie M, Silvers Elizabeth R, Orav E John, Eguale Tewodros, Bates David W (2017), Evaluation of medication-related clinical decision support alert overrides in the intensive care unit., in Journal of critical care
, 39, 156-161.
Slight Sarah Patricia*, Beeler Patrick E* (*joint first authors), Seger Diane L, Amato Mary G, Her Qoua L, Swerdloff Michael, Dalleur Olivia, Nanji Karen C, Cho InSook, Maniam Nivethietha, Eguale Tewodros, Fiskio Julie M, Dykes Patricia C, Bates David W (2017), A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement., in BMJ quality & safety
, 26(3), 217-225.
Cahill Katherine N, Johns Christina B, Cui Jing, Wickner Paige, Bates David W, Laidlaw Tanya M, Beeler Patrick E (2017), Automated identification of an aspirin-exacerbated respiratory disease cohort., in The Journal of allergy and clinical immunology
, 139(3), 819.
Dalleur Olivia, Beeler Patrick E, Schnipper Jeffrey L, Donzé Jacques (2017), 30-Day Potentially Avoidable Readmissions Due to Adverse Drug Events., in Journal of patient safety
Cahill KN, Johns CB, Cui J, Wickner P, Bates DW, Laidlaw TM, Beeler PE (2017), Automated identification of an aspirin-exacerbated respiratory disease cohort, in The Journal of Allergy and Clinical Immunology
Her Qoua L, Amato Mary G, Seger Diane L, Beeler Patrick E, Slight Sarah P, Dalleur Olivia, Dykes Patricia C, Gilmore James F, Fanikos John, Fiskio Julie M, Bates David W (2016), The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting., in Journal of the American Medical Informatics Association : JAMIA
, 23(5), 924-33.
Donzé Jacques D*, Beeler Patrick E* (*joint first authors), Bates David W (2016), Impact of Hyponatremia Correction on the Risk for 30-Day Readmission and Death in Patients with Congestive Heart Failure., in The American journal of medicine
, 129(8), 836-42.
Beeler Patrick E, Orav E John, Seger Diane L, Dykes Patricia C, Bates David W (2016), Provider variation in responses to warnings: do the same providers run stop signs repeatedly?, in Journal of the American Medical Informatics Association : JAMIA
, 23(e1), 93-8.
Her QL, Seger DL, Amato MG, Beeler PE, Dalleur O, Slight SP, Dykes PC, Bates DW (2016), Development of an algorithm to assess appropriateness of override non-formulary medication alerts in a computer provider order entry system, in Am J Health Syst Pharm
Her Qoua L, Seger Diane L, Amato Mary G, Beeler Patrick E, Dalleur Olivia, Slight Sarah P, Dykes Patricia C, Bates David W (2016), Development of an algorithm to assess appropriateness of overriding alerts for nonformulary medications in a computerized prescriber-order-entry system., in American journal of health-system pharmacy : AJHP : official journal of the American Society of Heal
, 73(1), 34-45.
Beeler Patrick Emanuel, Bates David Westfall, Hug Balthasar Luzius (2014), Clinical decision support systems., in Swiss medical weekly
, 144, 14073-14073.
Dalleur O, Beeler PE, Schnipper JL, Donzé J, 30-day potentially avoidable readmissions due to adverse drug events, in J Patient Saf
Slight Sarah P.*, Beeler Patrick E.* (*co-first authors), Seger Diane L., Amato Mary G., Her Qoua L., Swerdloff Michael, Dalleur Olivia, Nanji Karen C., Cho Insook, Maniam Nivethietha, Eguale Tewodros, Fiskio Julie M., Dykes Patricia C., Bates David W., A Cross-Sectional, Observational Study of High Override Rates of Drug Allergy Alerts in Inpatient and Outpatient Settings and Opportunities for Improvement, in BMJ Quality & Safety
Her QL, Amato MG, Seger DL, Beeler PE, Slight SP, Dalleur O, Dykes PC, Gilmore JF, Fanikos J, Fiskio JM, Bates DW, The Frequency of Inappropriate Non-Formulary Medication Alert Overrides in the Inpatient Setting, in J Am Med Inform Assoc.
Health information technology has the potential to increase quality of care and reduce costs. Several studies have shown that computerized physician order entry in combination with clinical decision support (CDS) is able to substantially improve patient safety. However, the psychological phenomenon called ‘alert fatigue’ limits the impact of CDS. Peterson and Bates describe alert fatigue as the mental state that is the result of a high number of alerts consuming time and mental energy, therefore increasing the risk of overriding alerts and missing potentially important notifications. In order to maximize the impact of CDS some authors recommend to reduce the number of false positive alerts, to include clear information within the alert, and to use non-interruptive reminders whenever possible, instead of disrupting the workflow.At the Brigham and Women’s Hospital (BWH), Boston MA, research has been conducted to reduce the number of interruptive drug-drug interaction alerts to a minimum. These efforts resulted in a set of 15 high-priority drug-drug interactions for which warnings should be generated in all electronic health records. At the University Hospital Zurich (USZ), an on-demand drug-drug interaction checker has been implemented in order to avoid alert fatigue. Further, an algorithm reminding physicians to consider ordering prophylaxis against venous thromboembolism has been investigated and incrementally improved during almost 7 years. These non-interruptive reminders increased the rate of appropriate thromboprophylaxis and had a sustained impact. A recent study showed that the new version of the algorithm specifically recognized unnecessary reminders and reduced the reminder burden by 62%, thus minimizing the risk of alert fatigue.