Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
复制标题
DOI：
10.1186/s12911-017-0430-8
复制
发表时间：
2017-04-10
影响因子：
3.5
通讯作者：
with the HITEC Investigators
中科院分区：
文献类型：
--
作者：
Ancker JS;Edwards A;Nosal S;Hauser D;Mauer E;Kaushal R;with the HITEC Investigators
尽管警觉疲劳被指责为当代临床决策支持系统中高覆盖率的原因，但警觉疲劳的概念定义不明确。我们测试了两种可能的警报疲劳机制产生的假说：(A)与工作量、工作复杂性和努力相关的认知超负荷，以区分信息性警报和非信息性警报，以及(B)随着时间的推移重复暴露于相同警报而导致的脱敏。使用2010年1月至2013年6月112名门诊初级保健临床医生的电子健康记录数据(药物警报和临床实践提醒)进行的回溯性队列研究。认知过载假设是，工作量越大(相遇次数、患者数量)、工作复杂性(患者共病、每次相遇警报)越高，警报接受度越低，信息价值较低的警报越多(同一年同一患者的重复警报)。脱敏假设是，对于新部署的警报，接受率在最初的峰值之后会下降。平均而言，初级保健临床医生收到的四分之一的药物警报和三分之一的临床提醒是同一患者在同一年内重复收到的。警报接受度与工作复杂性和重复警报有关，但与工作量无关。每次遇到每多收到一条提醒，接受提醒的可能性就会下降30%，重复提醒的比例每增加5个百分点，接受提醒的可能性就会下降10%。新部署的提醒没有显示随着时间的推移应答率下降的模式，这与脱敏是一致的。有趣的是，执业护士接受药物警报的可能性是医生的4倍。临床医生不太可能接受警报，因为他们收到的警报更多，特别是更多的重复警报。没有证据表明工作量本身的影响，也没有证据表明新部署的警报随着时间的推移而脱敏。减少患者内部的重复可能是减少警报覆盖和警报疲劳的一个有希望的目标。
Although alert fatigue is blamed for high override rates in contemporary clinical decision support systems, the concept of alert fatigue is poorly defined. We tested hypotheses arising from two possible alert fatigue mechanisms: (A) cognitive overload associated with amount of work, complexity of work, and effort distinguishing informative from uninformative alerts, and (B) desensitization from repeated exposure to the same alert over time. Retrospective cohort study using electronic health record data (both drug alerts and clinical practice reminders) from January 2010 through June 2013 from 112 ambulatory primary care clinicians. The cognitive overload hypotheses were that alert acceptance would be lower with higher workload (number of encounters, number of patients), higher work complexity (patient comorbidity, alerts per encounter), and more alerts low in informational value (repeated alerts for the same patient in the same year). The desensitization hypothesis was that, for newly deployed alerts, acceptance rates would decline after an initial peak. On average, one-quarter of drug alerts received by a primary care clinician, and one-third of clinical reminders, were repeats for the same patient within the same year. Alert acceptance was associated with work complexity and repeated alerts, but not with the amount of work. Likelihood of reminder acceptance dropped by 30% for each additional reminder received per encounter, and by 10% for each five percentage point increase in proportion of repeated reminders. The newly deployed reminders did not show a pattern of declining response rates over time, which would have been consistent with desensitization. Interestingly, nurse practitioners were 4 times as likely to accept drug alerts as physicians. Clinicians became less likely to accept alerts as they received more of them, particularly more repeated alerts. There was no evidence of an effect of workload per se, or of desensitization over time for a newly deployed alert. Reducing within-patient repeats may be a promising target for reducing alert overrides and alert fatigue.