Background Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The “pop-up” or interruptive alert is often employed as it requires providers to acknowledge receipt of an alert by taking an action despite the potential negative effects of workflow interruption. We noted a persistent upward trend of interruptive alerts at our institution and increasing requests for new interruptive alerts. Objectives Using Institute for Healthcare Improvement (IHI) quality improvement (QI) methodology, the primary objective was to reduce the total volume of interruptive alerts received by providers. Methods We created an interactive dashboard for baseline alert data and to monitor frequency and outcomes of alerts as well as to prioritize interventions. A key driver diagram was developed with a specific aim to decrease the number of interruptive alerts from a baseline of 7,250 to 4,700 per week (35%) over 6 months. Interventions focused on the following key drivers: appropriate alert display within workflow, clear alert content, alert governance and standardization, user feedback regarding overrides, and respect for user knowledge. Results A total of 25 unique alerts accounted for 90% of the total interruptive alert volume. By focusing on these 25 alerts, we reduced interruptive alerts from 7,250 to 4,400 per week. Conclusion Systematic and structured improvements to interruptive alerts can lead to overall reduced interruptive alert burden. Using QI methods to prioritize our interventions allowed us to maximize our impact. Further evaluation should be done on the effects of reduced interruptive alerts on patient care outcomes, usability heuristics on cognitive burden, and direct feedback mechanisms on alert utility.

Each variable was added separately in the univariate models, and the variables that were found to be significantly associated with hospitalization (P , 0.05) in the univariate models were included in the multivariable models.

Tobacco use is one of the biggest public health threats the world has ever faced and leads not only to human loss, but also heavy social and economic costs. It is claiming the lives of nearly 5.4 million people a year worldwide. 1 Burden in South East Asia region is one of the highest among WHO regions. 1 Tobacco is one of the major causes of death and disease in India, accounting for nearly 0.9 million deaths and 12 million people fall ill due to tobacco every year. 2 Nearly 275 million adults (15 years and above) in India (35% of all adults) are users of tobacco, according to the Global Adult Tobacco Survey India, 2009-10. Tobacco use is a major risk factor for many chronic diseases including lung diseases, cardiovascular diseases and stroke. Among other diseases, tobacco use increases risk for lung and oral cavity cancers. 3 Tobacco use accounts for one in six deaths due to non-communicable diseases (NCDs). In India tobacco consumption pushes approximately 150 million people in poverty. 3 India is the second largest consumer and third largest producer of tobacco and a plethora of tobacco products are available at very low prices. Tobacco products are made entirely or partly of leaf tobacco as raw material, ABSTRACT Background: Tobacco use is one of the important preventable causes of death and a leading public health problem all over the world. Tobacco is killing half of the people who use it. Globally, it kills nearly 6 million people. If current trends continue, by 2030 tobacco use is estimated to kill more than 8 million people worldwide each year. Present study carried out to determine prevalence and pattern of tobacco usage among urban slum dwellers. Methods: A cross sectional study conducted in urban slum of the urban health training center area of VIMS & RC, Bengaluru. Among adults aged 18 years and above, sample size of 370 selected by simple random sampling and interviewed by using semi structured questionnaire. Results: Prevalence of current tobacco users is 84.3% of which 28.9% are daily users. The commonest cause for starting tobacco use was due to offering in occasions (31.2%) and for maintenance was addiction (57.4%). Cigarettes (15.1%) and beedis (15.1%) were common smoking forms of tobacco and Betel quid with tobacco (40.3%) and pan masala (28.6%) were most common smokeless forms. Among the subjects 45.7% are exposed to second hand smoke in their homes, 63.2% are aware of health hazards, 95.71% are willing to quit tobacco at some point of time. Conclusions: Prevalence of tobacco use is high in the urban slums and many more are exposed to second hand smoke. Many want to quit tobacco but are unable to get proper assistance.