JMIR Publications

ABSTRACT

Background:

Alert fatigue is unavoidable when many useless alerts are generated in response to a small number of useful alerts. It is necessary to increase the effectiveness of the CDSS by understanding physicians’ responses.

Objective:

To understand the CDSS and physicians’ behavior, this study evaluated the clinical appropriateness of alerts and the corresponding physicians’ responses in a medication-related passive alert system.

Methods:

Data on medication-related orders, alerts, and patients’ electronic medical records (EMR) were analyzed. The analyzed data were generated between August 2019 and June 2020 while the patient was in the emergency department. We evaluated the appropriateness of alerts and physicians’ response for a subset of 382 alert cases and classified them.

Results:

We found that only 7.3% of the alerts were clinically appropriate. Regarding physicians’ response appropriateness about alerts, 92.7% were deemed appropriate. In the classification of alerts, only 3.4% of alerts were successfully triggered, and 2.1% alerts were inappropriate in both alert clinical relevance and physician’s response. In this study, the override rate was 93.0%.

Conclusions:

We evaluated the appropriateness of alerts and physicians’ responses through detailed chart review of the medication-related passive alert system. An excessive number of unnecessary alerts are generated because the algorithm operates as a rule base without reflecting the individual condition of the patient. It is important to maximize the value of the CDSS by comprehending physicians' responses.