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Reducing Alert Fatigue in Healthcare by Engaging the At-Home Care Team

One of the by-products of the increasing use of technology in healthcare is that there are more and more alerts being sent to care providers. These range from automatic “drug safety alerts” sent to clinicians each time they prescribe a drug via a Computerized Physician Order Entry (CPOE) system, to patient monitoring deployed in a hospital setting, to systems used in the home to do everything from keep track of medication, to monitoring patient vitals, to determining whether a patient has taken a spill.  What all of the smart technology now being used does is generate a vast amount of data. And that data, in turn, generates a vast number of alerts.

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Just how many alerts are being generated?

A 2014 study found that the physiologic monitors, in an academic hospital's 66 adult intensive care unit, beds generated more than 2 million alerts in one month, translating to 187 warnings per patient per day. According to another study, CPOE systems generate warnings for 3%–6% of all orders that are entered, meaning that a physician could easily receive dozens of warnings each day. (Source: Patient Safety Net, Agency for Healthcare Research and Quality, US Department of Health and Human Services)

As more and more technology is used in healthcare, as the population ages and requires more healthcare, the number of alerts that clinicians receive on a daily basis has the potential to increase to the point where the information is no longer meaningful or have much efficacy. That point may well have been reached. As far back as 2006, a study reported that the drug safety alerts coming from CPOE systems were “overridden by clinicians in 49% to 96% of cases.” (Source: National Center for Biotechnology Information, National Institutes for Health.)

Alert fatigue – choosing to ignore alerts -  has set in, and it’s worrisome.

“The issue of alert fatigue is that we are not just sending alerts that are considered to be irrelevant, but when you get enough of those, even the alerts that are important are disregarded,” said Jon D. Duke, MD, assistant professor at the Indiana University School of Medicine. Several studies have found the ignore rate for alerts averages between 80% and 90%. (Source: previously cited Patient Safety Net article)

Yet alerts are critical. They may be interruptive, they may be frustrating, and there may be too many of them. But, at their best, they do enable clinicians to provide better healthcare. They can save lives.

And as technology allows people recovering from surgery to heal at home, helps reduce the number of office and hospital visits required for the chronically ill, and enables our aging population to remain in their homes, we will need to find a better way of taking advantage of the growing number of alerts that will be generated on the home front.

One way to address the “alert fatigue” problem is to engage the at-home care team, the family and friends and helpers who take part in patient care. “Low severity” alerts can be directed to these people, who are on the scene or nearby. These are individuals who have a personal interest in a patient’s wellbeing – and, in many cases, the time, ability, and energy to intervene by following clinician-provided instructions.

Take the example of a patient recovering at home from recent knee-replacement surgery. The patient has reported an elevated pain level for the past 24 hours. Instead of immediately raising that notification to the clinical team, the at-home care team can receive the first alert, and, with the right information provided to them, deliver “front line support”. This support can include making sure that the patient is taking the prescribed pain medication, and is following prescription instructions. If the patient continues to report an elevated pain level, into the next day – or whatever period of time has been determined by the clinician -  the alert severity can be increased. The clinical team now becomes directly involved. But if the pain level has decreased, the clinicians will not have been interrupted. And when you multiply out the number of potential alerts that have been avoided, the likelihood of overwhelming alert fatigue setting in are reduced.

 

Bill Cava