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

BACKGROUND: Electronic 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. OBJECTIVE: To test the hypothesis time to se...

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Autores principales: Harrison, Andrew M., Thongprayoon, Charat, Aakre, Christopher A., Jeng, Jack Y., Dziadzko, Mikhail A., Gajic, Ognjen, Pickering, Brian W., Herasevich, Vitaly
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PeerJ Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354075/
https://www.ncbi.nlm.nih.gov/pubmed/28316887
http://dx.doi.org/10.7717/peerj.3083
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author Harrison, Andrew M.
Thongprayoon, Charat
Aakre, Christopher A.
Jeng, Jack Y.
Dziadzko, Mikhail A.
Gajic, Ognjen
Pickering, Brian W.
Herasevich, Vitaly
author_facet Harrison, Andrew M.
Thongprayoon, Charat
Aakre, Christopher A.
Jeng, Jack Y.
Dziadzko, Mikhail A.
Gajic, Ognjen
Pickering, Brian W.
Herasevich, Vitaly
author_sort Harrison, Andrew M.
collection PubMed
description BACKGROUND: Electronic 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. OBJECTIVE: To 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 DESIGN: In 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. RESULTS: The 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. CONCLUSION: Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting.
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spelling pubmed-53540752017-03-17 Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting Harrison, Andrew M. Thongprayoon, Charat Aakre, Christopher A. Jeng, Jack Y. Dziadzko, Mikhail A. Gajic, Ognjen Pickering, Brian W. Herasevich, Vitaly PeerJ Bioinformatics BACKGROUND: Electronic 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. OBJECTIVE: To 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 DESIGN: In 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. RESULTS: The 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. CONCLUSION: Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting. PeerJ Inc. 2017-03-14 /pmc/articles/PMC5354075/ /pubmed/28316887 http://dx.doi.org/10.7717/peerj.3083 Text en ©2017 Harrison et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.
spellingShingle Bioinformatics
Harrison, Andrew M.
Thongprayoon, Charat
Aakre, Christopher A.
Jeng, Jack Y.
Dziadzko, Mikhail A.
Gajic, Ognjen
Pickering, Brian W.
Herasevich, Vitaly
Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting
title Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting
title_full Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting
title_fullStr Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting
title_full_unstemmed Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting
title_short Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting
title_sort comparison of methods of alert acknowledgement by critical care clinicians in the icu setting
topic Bioinformatics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354075/
https://www.ncbi.nlm.nih.gov/pubmed/28316887
http://dx.doi.org/10.7717/peerj.3083
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