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Appl Clin Inform 2021; 12(02): 355-361
DOI: 10.1055/s-0041-1729167
Research Article

Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions

Kinjal Gadhiya
1   Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle Harrisburg, Pennsylvania, United States
,
Edgar Zamora
1   Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle Harrisburg, Pennsylvania, United States
,
Salim M. Saiyed
2   Department of Clinical Informatics, University of Pittsburgh Medical Center Pinnacle, Harrisburg, Pennsylvania, United States
,
David Friedlander
3   Department of Internal Medicine, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio, United States
,
David C. Kaelber
4   Department of Pediatrics, MetroHealth System, Case Western Reserve University, Cleveland, Ohio, United States
5   Population and Quantitative Health Sciences, MetroHealth System, Case Western Reserve University, Cleveland, Ohio, United States
6   Center for Clinical Informatics Research and Education, MetroHealth System, Case Western Reserve University, Cleveland, Ohio, United States
› Author Affiliations Funding None.
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Abstract

Background Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates.

Objectives This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions.

Methods Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden.

Results A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents.

Conclusion Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.

Keywords

drug alerts - drug fatigue - desensitization - salience rate - clinical decision support system

Protection of Human and Animal Subjects

No human subjects were involved in this project. The Institutional Review Board (IRB) was consulted, per guidelines at each institution, an IRB protocol approval was obtained as required by each institution. Program director approval was obtained from each residency program.




Publication History

Received: 17 August 2020

Accepted: 22 March 2021

Article published online:
28 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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