Alert Fatigue in Healthcare

4 Paths to minimize alert fatigue in healthcare

While long an issue in IT, alert fatigue in healthcare has only recently been recognized as a significant issue. In healthcare, the term alert fatigue describes how busy workers become desensitized to safety alerts resulting from clinical decision support (CDS) systems or electronic health records (EHR) and as a result ignore or fail to respond appropriately to warnings from these technologies. Given the high stakes associated with alert fatigue in healthcare, it is vital that any proposed solution enables high stakes alerts to rise to the surface and suppresses the volume of unimportant ones.

The goal of this blog is to further understand the mechanisms which cause alert fatigue in healthcare and look at ways that hospitals can minimize alert fatigue’s impacts on practitioners and their patients. To that end, this blog will look at :

• Causes – what is alert fatigue and which technologies in the hospital setting are at fault for creating the burden
• Impact – how do we see the impacts of alert fatigue
• Ways to address – how can alert fatigue be mitigated with secure messaging

Causes of alert fatigue in healthcare

“When providers are bombarded with warnings, they will predictably miss important things…. If you see enough nonsense, you’ll simply begin ignoring it.”

Healthcare Finance News

The major cause of alert fatigue in healthcare is that the alerts practitioners receive are inconsequential. These alerts are enabled by the widespread use of EHRs and other technologies. Yet practitioners often end up suppressing or ignoring these alerts or overriding them.

Indeed, the numerous computerized systems which dot the hospital’s landscape are designed to raise awareness but in the end, do just the opposite. In the case of potentially harmful drug interactions, physicians are supposed to receive alerts when a dangerous or a deadly combination has been prescribed to a patient. But a six year study carried out by the VA showed that doctors frequently override and ignore the drug interaction alert they may get on their smartphone. Nearly three fourths of the overrides were considered “critical drug-drug interactions.”

Indeed, drug interaction alerts bubbled to the top of the list when examining the causes of alert fatigue. In the case of drug interactions, many of the alerts lacked specificity, necessary data and clear action steps. A pharmacists’ investigation of drug interactions in a hospital setting revealed that the typical hospital system generated 243,803 drug interaction alerts and resulted in 668 overridden alerts per day.

Impacts

It has been well-established that false alarms reduce responsiveness to “real” alarms and also reduce overall performance on tasks interrupted by alarms.  When practitioners are experiencing this mix of excessive false alarms, their ability to respond to real patient needs is deprecated. They quality of care they are able to provide is diminished. In essence, a proliferation of alerts that are intended to improve safety actually results in a paradoxical increase in the chance patients will be harmed.

This eventuality was seen most acutely in two high profile cases. In a 2011 Boston Globe investigation,   more than 200 deaths over a 5-year period were attributable to failure to appropriately heed alarms from physiologic monitoring systems. Another well-known incident highlights how a hospitalized teenager received a 38-fold overdose of an antibiotic, in large part because the ordering physician had been advised by colleagues to “just ignore the alerts.”

Alert fatigue solutions

To mitigate alert fatigue, hospitals need to consider the following alerting and secure messaging solution:

1) Increase alert specificity by creating tiered alerts

Increasing alert specificity means that healthcare relies on making meaningful connections between the medication knowledge base and the severity of alert. This is currently not achieved in the modern EHR scenario. However, by producing smarter, more relevant alerts that consider the context of patient needs and conditions, physicians will only receive high priority alerts that are relevant.

For example, it is well known that new-born babies have elevated heart rates when they cry. As such, it would make no sense to flood nurses with irrelevant alarms from bedside monitors, which are excessively activated when an infant cries and his heart rate increases.

Instead, alerts need to be tailored to patient characteristics and integrated with smartphone technology that can handle intelligent alerts.  Alerts should be tiered according to severity and warnings need to be created to ensure that actions are consequential. It makes no sense to alert practitioners if there is no action they can take.

Furthermore, only high-level and severe alerts should interrupt a practitioner from their routines. This eliminates the need for nurses and doctors to consistently suppress the alerts around them and instead allows only the truly relevant alerts to interrupt the flow of care.

2)Make sure alerts come with context

Additionally, alerts should arrive with context. That is, in order to make alerts actionable, they need to come with instructions that make it immediately clear to the practitioner what they need to do in order to remedy the situation.

3)Minimize cognitive overload by providing  relevant alerts to the smartphone

By having tiered alerts and ensuring that they come with contextual messages, alerts can start to become actionable. Given the high incidence of smartphone communications in healthcare,  it becomes logical to have high priority alerts sent to practitioners’ smartphone. In this manner, critical clinical communications can be handled effectively and efficiently.

With a sophisticated smartphone application like OnPage, hospitals can ensure that critical alerts, high priority alerts are sent to practitioners’ devices and that they will receive concise messaging that indicates the situation at hand. Additionally, practitioners are ensured that they will not miss the alerts as they often do with pagers.

Conclusion

The causes of alert fatigue have been well documented in this report. Alert fatigue is due to the excessive number of alarms, alerts and resulting cognitive overload put on hospital staff. As noted, the inability to correctly bring the important alerts to the top impacts the quality of care which patients receive and could even result in dire consequences.

However, when practitioners have access to tiered alerting and communications methods such as the powerful and robust clinical communications platform provided by OnPage, they can minimize the number of inactionable and unconsequential alerts. Additionally, they can minimize the chance for errors.

OnPage’s HIPAA-compliant critical messaging service enables healthcare providers to receive alerts via encrypted and secure text communication methods. OnPage messages are SSL encrypted and can only be viewed by message participants. Furthermore, OnPage has remote wipe capabilities to further ensure HIPAA compliance.

By decreasing the number of false alerts  that physicians and nurses receive, OnPage can significantly decrease the level of practitioners’ alert fatigue and improve overall patient care.

To learn more about how to reduce alert fatigue in healthcare, contact us.