Clinical Decision Support and Implications for the Clinician Burnout Crisis

Janković, Ivana; Chen, Jonathan

doi:10.1055/s-0040-1701986

Cited by 33 publications

(23 citation statements)

References 105 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A growing body of work supports that alerts contribute to EHR user burnout. 16 Once implemented, alerts need to be periodically evaluated to determine if they should remain in place, be altered, or be eliminated/replaced with a different tool. Once alerts are created, organizations may be hesitant to turn them off due to safety or regulatory concerns, despite high burden on clinicians.…”

Section: Discussionmentioning

confidence: 99%

Lessons Learned from Creating Alert Governance during an Electronic Health Record Transition

Stoffel,

Desai,

Laine

et al. 2022

ACI open

View full text Add to dashboard Cite

Background Our multihospital transition to a single electronic health record (EHR) provided an opportunity to transform alert governance. Our case provides insights into the unique challenges and opportunities of creating governance during a transition to meet both implementation and future alert management needs. ObjectivesThis case report describes the efforts of UW Medicine Information Technology Services to advance alert governance during EHR transition and highlights the opportunities to improve care quality and provider experience within a changing environment. Methods We used a multidisciplinary approach and external evidence to define governance for provider-facing interruptive alerts. We established the context for our governance efforts with a systemic environmental scan. We used literature review and expert consultation to determine alert design and performance best practices, sought to design postimplementation evaluation tools, and engaged clinical stakeholders to help with decision-making. Results We created alert design and implementation tools and an alert approval process, eliminating 21 unnecessary alerts prior to implementation. We developed prototype evaluation metrics and enlisted clinical owners for postimplementation optimization of 221 alerts. Conclusion We leveraged the fluid environment of our EHR implementation to rapidly build a provider-led governance infrastructure to meet immediate transitional needs and to facilitate future alert maintenance and improvement.

show abstract

Section: Discussionmentioning

confidence: 99%

Lessons Learned from Creating Alert Governance during an Electronic Health Record Transition

Stoffel,

Desai,

Laine

et al. 2022

ACI open

View full text Add to dashboard Cite

show abstract

“…Therefore, investigating the usability of CCDS systems is essential for developing efficient and functional systems. In particular, alarm fatigue is a well-established usability concern for CCDS systems [ 109 ]. Alarm fatigue occurs when clinicians become desensitized to frequent inappropriate alarms and begin ignoring or overriding alerts, reducing the effectiveness of alert systems and potentially impacting patient outcomes [ 109 , 110 ].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, alarm fatigue is a well-established usability concern for CCDS systems [ 109 ]. Alarm fatigue occurs when clinicians become desensitized to frequent inappropriate alarms and begin ignoring or overriding alerts, reducing the effectiveness of alert systems and potentially impacting patient outcomes [ 109 , 110 ]. To prevent alarm fatigue, CCDS systems must be carefully calibrated to avoid unnecessary frequent alerting [ 109 , 110 ].…”

Section: Discussionmentioning

confidence: 99%

“…Alarm fatigue occurs when clinicians become desensitized to frequent inappropriate alarms and begin ignoring or overriding alerts, reducing the effectiveness of alert systems and potentially impacting patient outcomes [ 109 , 110 ]. To prevent alarm fatigue, CCDS systems must be carefully calibrated to avoid unnecessary frequent alerting [ 109 , 110 ]. None of the studies reported in this review investigated alarm fatigue in response to the implemented CCDS system, despite its importance for successful CCDS use.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: Scoping Review

Ackermann¹,

Baker²,

Festa³

et al. 2022

JMIR Med Inform

View full text Add to dashboard Cite

Background Sepsis is a severe condition associated with extensive morbidity and mortality worldwide. Pediatric, neonatal, and maternal patients represent a considerable proportion of the sepsis burden. Identifying sepsis cases as early as possible is a key pillar of sepsis management and has prompted the development of sepsis identification rules and algorithms that are embedded in computerized clinical decision support (CCDS) systems. Objective This scoping review aimed to systematically describe studies reporting on the use and evaluation of CCDS systems for the early detection of pediatric, neonatal, and maternal inpatients at risk of sepsis. Methods MEDLINE, Embase, CINAHL, Cochrane, Latin American and Caribbean Health Sciences Literature (LILACS), Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, and ProQuest Dissertations and Theses Global (PQDT) were searched by using a search strategy that incorporated terms for sepsis, clinical decision support, and early detection. Title, abstract, and full-text screening was performed by 2 independent reviewers, who consulted a third reviewer as needed. One reviewer performed data charting with a sample of data. This was checked by a second reviewer and via discussions with the review team, as necessary. Results A total of 33 studies were included in this review—13 (39%) pediatric studies, 18 (55%) neonatal studies, and 2 (6%) maternal studies. All studies were published after 2011, and 27 (82%) were published from 2017 onward. The most common outcome investigated in pediatric studies was the accuracy of sepsis identification (9/13, 69%). Pediatric CCDS systems used different combinations of 18 diverse clinical criteria to detect sepsis across the 13 identified studies. In neonatal studies, 78% (14/18) of the studies investigated the Kaiser Permanente early-onset sepsis risk calculator. All studies investigated sepsis treatment and management outcomes, with 83% (15/18) reporting on antibiotics-related outcomes. Usability and cost-related outcomes were each reported in only 2 (6%) of the 31 pediatric or neonatal studies. Both studies on maternal populations were short abstracts. Conclusions This review found limited research investigating CCDS systems to support the early detection of sepsis among pediatric, neonatal, and maternal patients, despite the high burden of sepsis in these vulnerable populations. We have highlighted the need for a consensus definition for pediatric and neonatal sepsis and the study of usability and cost-related outcomes as critical areas for future research. International Registered Report Identifier (IRRID) RR2-10.2196/24899

show abstract

“… 14 – 16 Additionally, these tools have been criticized for contributing to burnout through alert fatigue, information overload and workflow disruption. 11 , 17 …”

mentioning

confidence: 99%

Implementation of an Electronic Health Record Integrated Clinical Pathway Improves Adherence to COVID-19 Hospital Care Guidelines

Sangal

Liu

Cole

et al. 2022

American Journal of Medical Quality

View full text Add to dashboard Cite

Background: During the COVID-19 pandemic, frequently changing guidelines presented challenges to emergency department (ED) clinicians. The authors implemented an electronic health record (EHR)-integrated clinical pathway that could be accessed by clinicians within existing workflows when caring for patients under investigation (PUI) for COVID-19. The objective was to examine the association between clinical pathway utilization and adherence to institutional best practice treatment recommendations for COVID-19. Methods: The authors conducted an observational analysis of all ED patients seen in a health system inclusive of seven EDs between March 18, 2020, and April 20, 2021. They implemented the pathway as an interactive flow chart that allowed clinicians to place orders while viewing the most up-to-date institutional guidance. Primary outcomes were proportion of admitted PUIs receiving dexamethasone and aspirin in the ED, and secondary outcome was time to delivering treatment. Results: A total of 13 269 patients were admitted PUIs. The pathway was used by 40.6% of ED clinicians. When clinicians used the pathway, patients were more likely to be prescribed aspirin (OR, 7.15; 95% CI, 6.2-8.26) and dexamethasone (10.4; 8.85-12.2). For secondary outcomes, clinicians using the pathway had statistically significant ( P < 0.0001) improvement in timeliness of ordering medications and admission to the hospital. Aspirin, dexamethasone, and admission order time were improved by 103.89, 94.34, and 121.94 minutes, respectively. Conclusions: The use of an EHR-integrated clinical pathway improved clinician adherence to changing COVID-19 treatment guidelines and timeliness to associated medication administration. As pathways continue to be implemented, their effects on improving patient outcomes and decreasing disparities in patient care should be further examined.

show abstract

Clinical Decision Support and Implications for the Clinician Burnout Crisis

Cited by 33 publications

References 105 publications

Lessons Learned from Creating Alert Governance during an Electronic Health Record Transition

Lessons Learned from Creating Alert Governance during an Electronic Health Record Transition

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: Scoping Review

Implementation of an Electronic Health Record Integrated Clinical Pathway Improves Adherence to COVID-19 Hospital Care Guidelines

Contact Info

Product

Resources

About