The Humans Factors and Ergonomic Society of Australia (HFESA) has produced a podcast featuring a conversation between Professor Melissa Baysari and Sharon Todd, the President of HFESA. The podcasts can be accessed via the HFESA website or the HFE Hub website.
Melissa Baysari is Professor of Human Factors and leads the Digital Health Human Factors Research Group at the University of Sydney. Her research group applies Human Factors methods and approaches to evaluate and optimise health technologies to support healthcare work and improve patient safety. Melissa has many ongoing collaborations with health services and government and her research has resulted in a number of significant changes being made to clinical information systems, as well as to hospital policy and work practices.
Understanding Alert Fatigue in Clinical Settings
The concept of alert fatigue in Electronic Medical Records (EMRs) is complex and multi-faceted. Research indicates that clinicians often face a deluge of alerts, which can result in desensitisation to even the most critical of warnings. The overload of alerts is not just an annoyance but poses a risk to patient safety. Clinicians, buried under a plethora of notifications, may inadvertently ignore vital alerts that could potentially prevent medical errors or adverse events.
One of the ways to tackle alert fatigue is through developing clinical decision support guidelines. These flowchart-like guidelines can help clinicians navigate the decision-making process more efficiently and determine when an alert is truly warranted. The idea is to make alerts the last resort in the decision-making chain, reducing their frequency and thereby increasing their significance. Interestingly, such guidelines are not just theoretical; they’re actively being trialled, with end-users themselves coming forward to test their effectiveness in real-world scenarios.
The Search for Evidence: Are Alerts Effective?
Despite the ubiquity of alerts in EMRs, little empirical evidence exists to confirm their effectiveness. One longitudinal study focused on drug-drug interaction alerts, the most common type of alert encountered by clinicians. Hospitals were categorised as either control or intervention groups, with the latter implementing the drug-drug interaction alerts. The preliminary findings indicate that the presence of these specific alerts doesn’t significantly reduce drug-drug interactions, casting doubt on their efficacy.
This lack of proven efficacy presents a dilemma: should ineffective alerts be removed or should they remain as they are? If a safety feature is found to be ineffective, continuing to use it can have its own set of consequences. For example, retaining superfluous alerts can contribute to negative perceptions of the EMR system and even lead to more serious issues like overlooking important alerts. This conundrum raises ethical and practical questions that healthcare providers and policy-makers must address.
Individual Variability and Alert Tolerance
The discussion on alert fatigue would be incomplete without acknowledging the role of individual variability. It appears that clinicians have different thresholds for how many alerts they can tolerate before they start ignoring them. An experimental study attempted to identify this threshold by using medical students as participants and monitoring their reactions to varying levels of alerts. Unfortunately, the study found too much variability to come up with a universal number, underscoring the complexity of human factors in the equation.
Not only do individuals vary in their tolerance levels, but the context in which they encounter these alerts also affects their perceptions and responses. For example, the importance of an alert may be perceived differently depending on other tasks the clinician is engaged in at the time. Previous experiences with alerts, even in non-clinical settings like using a word processor, can also influence how alerts are perceived and acted upon in clinical settings. These nuanced layers add complexity to designing an effective alert system in healthcare settings.
Why Tune In?
These podcasts are a series of educational podcasts from the Human Factors and Ergonomics Society of Australia (HFESA). These podcasts focus on the connection between human capabilities and good design. Their aim is to promote the field of Human Factors and Ergonomics and provide guidance and professional development.
This podcast is relevant to those interested in healthcare, technology implementation, and Human Factors and Ergonomics within clinical environments. Professionals like healthcare providers, medical researchers, hospital administrators, as well as academics focusing on healthcare informatics, will find invaluable insights in the discussion presented. The podcast not only explores the critical issue of alert fatigue in Electronic Medical Records but also delves into the multifaceted approaches needed for effective clinical decision support systems, making it a must-listen for anyone invested in patient safety and healthcare efficiency.
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Prepared by Michael Dubos