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%.