Clinicians continue hitting snooze button on patient alarms

The constant beeping of monitors or those technologies that fire off alerts can make hospital staff go numb. The reality is that patients are at risk when care teams override alerts. But technology must get smarter to overcome alert fatigue and deliver reliable alarms so clinicians can react quickly and with confidence.

Clinical decision support technologies have undoubtedly produced a range of benefits for clinicians by assisting them in making timely, informed, and higher-quality care decisions, yet every day, clinicians are exposed to a staggering number of system alerts—so many, in fact, that they become numb to them. One hospital study reported that an average of one critical alarm fired off every 90 seconds. So, on one hand, although fundamental shifts in care delivery have given clinicians the tools to act more quickly, on the other the consequences of ignoring alerts have proved deadly.

The problem arises when clinicians ignore both the irritating, clinically meaningless alarms and the critical alerts that warn of serious patient harm or a potential medical error or even the onset of a potentially life-threatening hospital infection. Alerts that have been designed to improve safety can actually increase the chances of patients being harmed.

Alert fatigue is now recognized as a significant patient safety hazard, with study after study reporting that physicians override a majority of alerts. In fact, some studies suggest that burdensome electronic-health-record alerts might also be contributors to the high turnover rate among physicians.

Technology is meant to assist clinicians, but it often turns out to be a hindrance that takes away from time spent with patients. Clinical decision support should help clinicians to do their jobs by enhancing their interactions with patients and improving patient safety and outcomes. But sometimes clinical decision support is thought of as simply a method of delivering alerts, which many clinicians find disruptive rather than helpful.

According to studies, 49 to 96% of alerts get overridden. Alert fatigue triggered by too many alerts that are irrelevant, not serious, or repeated is one of the primary reasons clinicians override alerts. Another likely contributor to alert fatigue is cognitive overload, wherein alerts with too much or too complex information or repeated alerts are received without the time or resources to process them.

One of the reasons for concern is that the high number of irrelevant alerts could cause clinicians to override important alerts, thereby resulting in reduced trust in the alert system and even the system as a whole. One study found that a typical clinical decision support system has 95% sensitivity but only 15% specificity when it comes to patients with, say, systemic inflammatory response syndrome who are likely to develop sepsis. The system would therefore trigger far more false alerts than it would genuine ones.

Such triggering is troubling given the documented effects of overridden alerts, with adverse events observed in 6% of alerts and with an 80% override rate. Findings that clinical-decision-support-system alerting had very little impact on reducing mortality have been attributed to poor delivery of clinical decision support. Indeed, most systems deliver sensitivity well below 50%.

The path forward

One way of addressing alert fatigue is to reduce the frequency of repeat alerts that get sent to the same clinician. Using clinical decision support tools that give hospitals and clinicians greater control over alerts, that give them the ability to filter and customize alerts to meet the needs of the environment, and that give them more-holistic capabilities have improved hospitals’ and clinicians’ responses to alerts.

However, it’s as important to understand the user’s information needs—including data presentation and work flow—in order to make it easy for practitioners to practice high-quality, evidence-based medicine centered on patients. Creative ways have to be developed that will shepherd clinicians toward better care practices and inject knowledge in an optimized way that is relevant, acceptable, and engaging.

Finally, tools are only as effective and accurate as the content that fuels them, and alerts must be underpinned by the latest evidence-based guidance.

The challenge will lie in overcoming disparate electronic health records, discrepant technology standards, slow adoption curves, and functional silos that prevent collaborative approaches to enhancement of the healthcare experience.

Source:

¹ Based on a 2010 investigation by the Boston Globe, which reported that alarm fatigue had played a role in the deaths of more than 200 hospital patients. The publication reported that at Johns Hopkins Hospital staff members documented an average of 942 alarms a day—the equivalent of one critical alarm going off every 90 seconds.