Abstract
Background
Retinopathy of prematurity (ROP) is the leading cause of preventable childhood blindness.
Guidelines recommend screening for infants with gestational age at birth <31 weeks
or birth weight ≤1,500 g. However, ensuring timely screening during readmissions after
birth is challenging.
Objectives
To analyze the performance of an interruptive alert at a large academic pediatric
hospital for identifying premature infants needing ROP screening upon hospital readmission
and to describe how data informed the transition to a non-interruptive dashboard.
Methods
The alert appeared for patients 1 to 365 days of age hospitalized in acute care or
pediatric intensive care and instructed providers to order an ophthalmology consult
from within the alert and to call ophthalmology for at-risk patients. For quality
improvement, the clinical decision support (CDS) advisory group evaluated the effectiveness
and efficiency of the alert. We extracted alert metrics from the hospital's enterprise
data warehouse, including the user response and feedback, patient characteristics
(age, birth gestational age, and birth weight), and any ophthalmology consultations.
We analyzed the percentage of encounters seen by ophthalmology using a statistical
process control chart during alert implementation and 6 months before and after.
Results
The alert appeared 3,309 times during 2,194 patient encounters usually. Users chose
“Accept and place order” for 43% (943/2,194) of encounters, but only 11% (102/943)
had an ophthalmology consult; 34% (53/155) of ophthalmology consultations occurred
in encounters with a final response other than “Accept and place order.” The intervention
was redesigned using a non-interruptive surveillance dashboard with greater specificity,
and the alert was de-implemented.
Conclusion
Analysis of a failed interruptive alert for identifying patients at risk for ROP led
to a transition to targeted surveillance using a dashboard. This case emphasizes the
importance of aligning the CDS modality to the clinical workflow, information availability,
and user decision-making needs and should be supported by governance.
Keywords
clinical decision support - quality improvement - retinopathy of prematurity - alert
fatigue - dashboard
