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How to avoid “alert fatigue”

  • Steven Shaha, Ph.D., DBA
  • 06/11/2015

Some of us remember the old days and the art of tuning a radio. We finely adjusted the dials as we approached channels to get a clear signal, filtering out all the static and noise. The classic case of optimizing the signal-to-noise ratio.

The art of optimizing our signal-to-noise ratio is alive and well when it comes to electronic health record (EHR) alerts. It’s important that alerts are relevant and meaningful to clinicians, or we run the risk of too much information becoming just noise. That’s the near-perfect definition of what we’ve come to refer to as “alert fatigue” among clinicians, which can be hazardous for everyone involved.

Meaningful alerts help improve clinical results

Here’s an example of how an organization not only optimized the signal-to-noise ratio, but conquered alert fatigue and improved clinical results. And all by addressing alerts for the need to complete the risk assessments for Deep Vein Thrombosis (DVT) and Venous Thrombolytic Embolism (VTE), which, for the purposes of simplicity in this blog post, I’ll refer to as blood clots.

Restated simply: The circulatory system works best when we move a lot, as is known by all clinicians.  But when patients are bedridden, blood can pool and form clots, especially in the lower extremities – legs. If a clot dislodges and reaches the heart, lung or brain, the results can be catastrophic.

Because patient safety is a top priority in hospitals, and DVTs and VTEs were considered avoidable through good care, the U.S. Federal Government no longer reimburses for care related to these preventable blood clots.  Smart organizations are using EHRs to remind clinicians to conduct timely DVT/VTE risk assessments.

One of our clients, a teaching hospital, started its prevention measures by alerting clinicians to complete all the recommended evidence-based risk assessments, once per shift, per patient. The result was over 25,000 alerts a month due to missing assessments which the organization hoped alerts would  improve through compliance.

For the first four months, the numerous alerts accomplished very little in improved compliance mainly because the clinicians predictably treated them as just noise. Busy clinicians clicked past them and compliance with risk assessments did not improve.

Strategies for addressing “alert fatigue”

There are different strategies for resolving the need for a host of risk assessments without inattention, and EHR capabilities are a key strategy. Some EHR systems are unfortunately much too rigid, however, and offer few options for tailoring alerts, or for altering the EHR to do the needed risk assessments automatedly. Some EHRs will even freeze up until clinicians comply with alerts, preventing them from doing anything else in the EHR.

However, this organization beautifully illustrates a higher-order strategy to resolve “alert fatigue.” After four months of struggling with low compliance rates, it customized its approach to DVT and VTE risk assessments. It redesigned data and clinical workflows including collection of key risk-related data elements of information upon admission, which made it easier to complete the risk assessment as an automated benefit of a programmable EHR computer system.

As a result, alerts were reduced by 97.4%, cutting out all of the noise, which improved adoption and compliance:

  

More relevant alerts for blood clot assessments helped one organization increase compliance by 145% and reduce rate of VTEs by 62.6%

 

Why it matters

As a direct result of this customized information-related workflow, the organization not only eliminated alert fatigue … it reduced DVT and VTE blood clot rates by 62.6%. Put another way, an estimated 167 people annually did not experience VTEs who statistically would have because of this organization’s work to improve care leveraging the locally programmable, adjustable and adaptable EHR.

Sometimes we get distracted with meeting healthcare requirements, and we forget the reason behind them. We hit a certain percentage target and move forward with a smile and congratulations. But we should stop and recognize that there’s deeper meaning on a human level, and that the programmable EHR can make better, safer care more commonplace with less alert fatigue and better data and documentation.

That’s a list of reasons why I’m a passionate advocate for Allscripts Sunrise™. Clinicians and their IT professional partners can team up to program the EHR solution to filter out the noise and provide optimal signal.  Organizations can tune in to the most relevant information for their clinicians, their role in the community and their patient populations. They can use the EHR as a powerful tool to help them improve the efficiency and efficacy of care. And that means better health for your loved ones, you and me.

 

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About the author

Steven H. Shaha, Ph.D., DBA, is a Professor at the Center for Policy & Public Administration, and the Principal Outcomes Consultant for Allscripts. Dr. Shaha received his first doctorate in Research Methods and Applied Statistics from UCLA and has taught and lectured at universities including Harvard, University of Utah, UCLA, Princeton, Cambridge and others. An internationally recognized thought leader, lecturer, consultant and outcomes researcher, Dr. Shaha has provided advisory and consulting work to healthcare organizations including the National Institutes for Health (NIH), and to over 50 non-healthcare corporations including RAND Corp, AT&T, Coca-Cola, Disney, IBM, Johnson & Johnson, Kodak, and Time Warner. Dr. Shaha has presented over 200 professional papers, has over 100 peer-reviewed publications in print, over 35 technical notes and two books. He served on the 15-member team that authored and piloted the Malcolm Baldrige National Quality Award for Health Care, and he contributed to the Baldrige for Education.

2 COMMENTS on How to avoid “alert fatigue”

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Alex says:

06/12/2015 at 7:25 am

It was a pleasure reading your article citing one hospitals’ commitment to DVT/VTE prevention. The Medical staff at our facility has a similar passion. Would it be possible to find out the hospital you refer to in your article? We share a similar appreciation for the scalability of the Allscripts platform. If permitted, our team would enjoy getting a fuller understanding of the workflow and the Allscripts configuration that was used. Thanks again.

Steve Shaha says:

06/12/2015 at 2:44 pm

Thanks for your interest, Alex. Always great to hear from other clients that are able to scale the Allscripts platform to meet their needs.

In fact, DVT/VTE assessment alerts will be the subject of the Client Outcomes Collaboration Program webinar on August 26, 2015. It will have more client examples and “how to” information. There’s more information about this program for Sunrise clients in ClientConnect: https://clientconnect.allscripts.com/groups/client-outcomes-collaboration-program/overview

In the meantime, we’ll reach out to you privately to see if there are ways we can connect you with other clients using this workflow.

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