Testing modes of computerized sepsis alert notification delivery systems

Dziadzko, Mikhail; Harrison, Andrew M.; Tiong, Ing; Pickering, Brian; Franco, Pablo Moreno; Herasevich, Vitaly

doi:10.1186/s12911-016-0396-y

Cited by 13 publications

(16 citation statements)

References 29 publications

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“…18,19 Surveys and studies evaluating most effective or preferred methods of alert delivery (pagers, electronic health record (EHR) based, cell phones) have found mixed results, although active alerts such as computer pop-ups and pharmacy interventions may be more effective than alert systems which do not automatically fit into the clinician workflow. [18][19][20] The development of this new BPA involved careful discussion of a number of potential triggers to identify critically ill patients in the ICU requiring attention and intervention. Our institution's SIRS alert is not used in ICUs, because these patients may often meet these criteria for a number of reasons other than sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…17 Alert fatigue and technical failure may be barriers to timely alert acknowledgment. 18,19 Surveys and studies evaluating most effective or preferred methods of alert delivery (pagers, electronic health record (EHR) based, cell phones) have found mixed results, although active alerts such as computer pop-ups and pharmacy interventions may be more effective than alert systems which do not automatically fit into the clinician workflow. 18–20…”

Section: Discussionmentioning

confidence: 99%

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Analysis of a new best-practice advisory on time to initiation of antibiotics in surgical intensive care unit patients with septic shock

Chanas

Volles

Sawyer

et al. 2018

Journal of the Intensive Care Society

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Background: Early administration of antibiotics in septic shock is associated with decreased mortality. Promptly identifying sepsis and eliciting a response are necessary to reduce time to antibiotic administration. Methods: A best-practice advisory was introduced in the surgical intensive care unit to identify patients with septic shock and promote timely action. The best-practice advisory is triggered by blood culture orders and vasopressor administration within 24 h. The nurse or provider who triggers the alert may send an automatic notification to the intensive care unit resident, clinical pharmacist, and charge nurse, prompting bedside response and closer evaluation. Patients who met best-practice advisory criteria in the surgical intensive care unit from May 2016 through March 2017 were included. Outcomes included changes in antibiotics within 24 h, response to best-practice advisory, and time-to-antibiotics. Timeto-antibiotics was compared between a retrospective pre-intervention period and a six-month prospective postintervention period defined by launch of the new best-practice advisory in September 2016. Data were analyzed by chi square, Mann-Whitney U, and Kruskal-Wallis. Results: During the first six months of best-practice advisory implementation, 191 alerts were triggered by 97 unique patients. Alert notification was transmitted in 79 best-practice advisories (41%), with pharmacist bedside response in 53 (67%). New antibiotics were started within 24 h following 83 best-practice advisories (43%). There was a trend toward decreased time-to-antibiotics following implementation of the best-practice advisory (7.4 vs. 4.2 h, p ¼ 0.057). Compared to the entire cohort, time-to-antibiotics was shorter when the team was notified and when a pharmacist responded to the bedside (4.2 vs. 1.6 vs. 1.2 hours). Conclusions: A new best-practice advisory has been effective at eliciting a rapid response and reducing the time-toantibiotics in surgical intensive care unit patients with septic shock. Team notification and pharmacist response are associated with decreased time-to-antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of a new best-practice advisory on time to initiation of antibiotics in surgical intensive care unit patients with septic shock

Chanas

Volles

Sawyer

et al. 2018

Journal of the Intensive Care Society

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“…Well-established biases and potential confounders are known to be present with this particular study design ( Straus et al, 2005 ); (2) Unlike the severe sepsis system alerts through AWARE (yellow or green icon alerts), the severe sepsis alerts through text paging were simulated. Comparing non-simulated alerts to simulated alerts may introduce additional confounders into the interpretation of the results of this study; (3) Although not investigated in this study, the feasibility of severe sepsis alert delivery using an EHR-based, automated mobile app for smartphones has been validated ( Dziadzko et al, 2016 ); (4) The significant range of clinical experience of clinician-participants introduces study bias. The potential application of this technology for the future of clinical practice and clinical research should not be ignored.…”

Section: Discussionmentioning

confidence: 99%

“…Time to alert acknowledgement has been validated as one proxy for time to recognition of sepsis by critical care clinicians ( Dziadzko et al, 2016 ). The failure of EHR-based, automated sepsis alert systems to be directly correlated with improvements in clinically meaningful endpoints is frequently attributed to limitations of detection algorithms and/or the need for clinical decision support (CDS) systems ( Semler et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting

Harrison

Aakre

Jeng

et al. 2017

PeerJ

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BackgroundElectronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored.ObjectiveTo test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system.Study DesignIn one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview.ResultsThe alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148) and 51% (N = 156) from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5) and median 2 min (N = 80) from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers.ConclusionAlert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting.

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“…It is also becoming increasingly relevant in general wards [ 2 ]. In the past decade, particularly in the context of the digital transformation of health care, vital sign monitoring has undergone constant change and is being transformed and augmented by important technological innovations such as less invasive sensors, remote monitoring technology [ 3 - 5 ], and artificial intelligence for clinical decision support [ 6 , 7 ]. Together, these innovations hold great promise for improving patient safety and health care provision [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation

Poncette¹,

Mosch²,

Stablo³

et al. 2022

JMIR Hum Factors

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Background Continuous monitoring of vital signs is critical for ensuring patient safety in intensive care units (ICUs) and is becoming increasingly relevant in general wards. The effectiveness of health information technologies such as patient-monitoring systems is highly determined by usability, the lack of which can ultimately compromise patient safety. Usability problems can be identified and prevented by involving users (ie, clinicians). Objective In this study, we aim to apply a human-centered design approach to evaluate the usability of a remote patient-monitoring system user interface (UI) in the ICU context and conceptualize and evaluate design changes. Methods Following institutional review board approval (EA1/031/18), a formative evaluation of the monitoring UI was performed. Simulated use tests with think-aloud protocols were conducted with ICU staff (n=5), and the resulting qualitative data were analyzed using a deductive analytic approach. On the basis of the identified usability problems, we conceptualized informed design changes and applied them to develop an improved prototype of the monitoring UI. Comparing the UIs, we evaluated perceived usability using the System Usability Scale, performance efficiency with the normative path deviation, and effectiveness by measuring the task completion rate (n=5). Measures were tested for statistical significance using a 2-sample t test, Poisson regression with a generalized linear mixed-effects model, and the N-1 chi-square test. P<.05 were considered significant. Results We found 37 individual usability problems specific to monitoring UI, which could be assigned to six subcodes: usefulness of the system, response time, responsiveness, meaning of labels, function of UI elements, and navigation. Among user ideas and requirements for the UI were high usability, customizability, and the provision of audible alarm notifications. Changes in graphics and design were proposed to allow for better navigation, information retrieval, and spatial orientation. The UI was revised by creating a prototype with a more responsive design and changes regarding labeling and UI elements. Statistical analysis showed that perceived usability improved significantly (System Usability Scale design A: mean 68.5, SD 11.26, n=5; design B: mean 89, SD 4.87, n=5; P=.003), as did performance efficiency (normative path deviation design A: mean 8.8, SD 5.26, n=5; design B: mean 3.2, SD 3.03, n=5; P=.001), and effectiveness (design A: 18 trials, failed 7, 39% times, passed 11, 61% times; design B: 20 trials, failed 0 times, passed 20 times; P=.002). Conclusions Usability testing with think-aloud protocols led to a patient-monitoring UI with significantly improved usability, performance, and effectiveness. In the ICU work environment, difficult-to-use technology may result in detrimental outcomes for staff and patients. Technical devices should be designed to support efficient and effective work processes. Our results suggest that this can be achieved by applying basic human-centered design methods and principles. Trial Registration ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173

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Testing modes of computerized sepsis alert notification delivery systems

Cited by 13 publications

References 29 publications

Analysis of a new best-practice advisory on time to initiation of antibiotics in surgical intensive care unit patients with septic shock

Analysis of a new best-practice advisory on time to initiation of antibiotics in surgical intensive care unit patients with septic shock

Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting

A Remote Patient-Monitoring System for Intensive Care Medicine: Mixed Methods Human-Centered Design and Usability Evaluation

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