JMIR Publications

ABSTRACT

Background:

Alerts, a key feature of Electronic Health Record (EHR) systems, intend to improve patient safety by providing timely information at the point of care. However, many EHR systems generate excessive alerts that are not immediately clinically relevant and that contribute to alert fatigue. Despite growing recognition of alert fatigue as a safety concern, clinicians’ experiences of alert fatigue and the broader system-level factors that contribute to it being experienced are not well understood.

Objective:

Use a human factors approach to comprehensively explore how alert fatigue is experienced by doctors, identify alert fatigue’s contributing factors, perceived influences and impacts, and strategies to address it in practice.

Methods:

Semi-structured interviews were conducted with junior doctors working in hospitals across Australia. Data were thematically analysed using a hybrid inductive and deductive approach, informed by the Safety Engineering Initiative for Patient Safety (SEIPS) and an information processing model.

Results:

Twenty doctors were interviewed. Alert fatigue was described to occur at different stages of information processing, including when alerts were not detected, superficially processed using mental shortcuts, or required excessive cognitive effort to interpret. When alerts were not detected or thoroughly processed, participants more often perceived impacts on patient safety and care quality, whereas when alerts required excessive cognitive effort interruptions, frustration, and time and effort loss were frequently reported. Contributors to alert fatigue were reported to include technology, task, and environmental factors such as the interface design and clinical relevance of alerts, and information overload from system alerts as well as other alerts and tasks. Alert fatigue was described to be experienced differently depending on provider characteristics, such as experiences with and knowledge of alerts, mood, and personality, and organisational factors including culture, shift type and time of day.

Conclusions:

Alert fatigue is not a binary concept but instead experienced on a continuum and influenced by interacting individual, technical and contextual factors. Addressing alert fatigue requires tailored interventions that target its different causes and outcomes. These could include technical and design improvements, changes to organisational practices, and individual customisation to reduce experiences of fatigue and accommodate differences in clinicians’ needs.