To provide ICU clinicians with evidence-based guidance on tested interventions that reduce or prevent alert fatigue within clinical decision support systems.
Systematic review of PubMed, Embase, SCOPUS, and CINAHL for relevant literature from 1966 to February 2017.
Focus on critically ill patients and included evaluations in other patient care settings, as well.
Identified interventions designed to reduce or prevent alert fatigue within clinical decision support systems.
Study selection was based on one primary key question to identify effective interventions that attempted to reduce alert fatigue and three secondary key questions that covered the negative effects of alert fatigue, potential unintended consequences of efforts to reduce alert fatigue, and ideal alert quantity. Data were abstracted by two reviewers independently using a standardized abstraction tool. Surveys, meeting abstracts, “gray” literature, studies not available in English, and studies with non-original data were excluded. For the primary key question, articles were excluded if they did not provide a comparator as key question 1 was designed as a problem, intervention, comparison, and outcome question. We anticipated that reduction in alert fatigue, including the concept of desensitization may not be directly measured and thus considered interventions that reduced alert quantity as a surrogate marker for alert fatigue. Twenty-six articles met the inclusion criteria.
Approaches for managing alert fatigue in the ICU are provided as a result of reviewing tested interventions that reduced alert quantity with the anticipated effect of reducing fatigue. Suggested alert management strategies include prioritizing alerts, developing sophisticated alerts, customizing commercially available alerts, and including end user opinion in alert selection. Alert fatigue itself is studied less frequently, as an outcome, and there is a need for more precise evaluation. Standardized metrics for alert fatigue is needed to advance the field. Suggestions for standardized metrics are provided in this document.
1Department of Pharmacy, Critical Care Medicine, Biomedical Informatics and Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
2Department of Pharmacy, UPMC, Pittsburgh, PA.
3Department of Anesthesia and Critical Care Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL.
4Department of Medicine, The University of Chicago, Chicago, IL.
5Division of General Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.
6Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom.
7Critical Care Division, Grady Health Systems, Atlanta, GA.
8Division of General Pediatrics, Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA.
9Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
10John Hopkins Health System, Baltimore, MD.
11Department of Physiological Nursing, University of California, San Francisco, CA.
12Clinical Engineering Professional Services, University of Virginia Health System, Charlottesville, VA.
13Department of Anesthesiology, Critical Care Medicine, Surgery and Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.
Supported, in part, by the Gordon and Betty Foundation, as a grant to the Society of Critical Care Medicine, Mount Prospect, IL.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
The authors disclosed that funding was provided by the Gordon and Betty Foundation, as a grant to the Society of Critical Care Medicine. Dr. O’Connor disclosed off-label product use of ignoring or bypassing alarms and alerts built into sensors, monitors, and computer decision support systems. Ms. McLean received funding from Edwards Lifesciences and the American Association of Critical Care Nurses. Dr. Winters received funding from performing medical legal work for a variety of law firms, UpToDate (royalties), and he disclosed that he is on the board of a start-up called Intellix Checklists, Inc.
For information regarding this article, E-mail: SLK54@pitt.edu