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

PeerJ

article

Andrew M. Harrison¹  Charat Thongprayoon²  Christopher A. Aakre³  Jack Y. Jeng⁴  Mikhail A. Dziadzko²  Ognjen Gajic⁵  Brian W. Pickering²  Vitaly Herasevich² 

[1] Medical Scientist Training Program, Mayo Clinic;Department of Anesthesiology, Mayo Clinic;Department of Internal Medicine, Mayo Clinic;Mayo Medical School, Mayo Clinic;Division of Pulmonology and Critical Care Medicine, Mayo Clinic

关键词: Implementation barriers;    Alert studies;    Simulation studies;    Electronic health record;    Intensive care unit;    Sepsis;   

DOI  :  10.7717/peerj.3083

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

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.

【 授权许可】

CC BY