Right Idea, Wrong Time: Focusing on Alert Timing for Effective Decision Support

Averi E. Wilson; Andrew P. Bain; Janet Webb; Christoph U. Lehmann; Brett Moran; Nainesh Shah; Ellen O'Connell

doi:10.1055/a-2605-4510

Applied Clinical Informatics, Inhaltsverzeichnis

Appl Clin Inform 2025; 16(04): 1200-1207
DOI: 10.1055/a-2605-4510

Special Issue on CDS Failures

Right Idea, Wrong Time: Focusing on Alert Timing for Effective Decision Support

Autor*innen

Averi E. Wilson

¹Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States

²Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
Andrew P. Bain

²Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States

³Department of Surgery, University of Texas Southwestern, Dallas, Texas, United States
Janet Webb

¹Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States

²Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
Christoph U. Lehmann

¹Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States

²Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
Brett Moran

⁴Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States

⁵Department of Clinical Informatics, Parkland Health, Dallas, Texas, United States
Nainesh Shah

²Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States

⁴Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States

⁶Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
Ellen O'Connell

²Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States

⁵Department of Clinical Informatics, Parkland Health, Dallas, Texas, United States

⁶Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States

Abstract

Background

Effective clinical decision support (CDS) interventions improve adherence to care guidelines, reduce prescribing errors, and, in some settings, decrease patient mortality. However, misalignment with the “Five Rights” framework, particularly regarding CDS timing in clinical workflows, can lead to implementation failures, alert fatigue, and physician burnout.

Objectives

This case series aimed to evaluate and redesign three interruptive CDS alerts at a large safety net health system to better align with clinician workflows, reduce interruptions, and improve compliance with care guidelines.

Methods

We analyzed three interruptive alerts using data from Epic's SlicerDicer tool, focusing on alert frequency, contributors to alert triggering, and user responses before and after intervention. Alerts were modified to improve their timing and relevance within the workflow.

Results

Modifications included retiming a human immunodeficiency virus screening alert to trigger during laboratory test orders, reducing alert firings by 87% while increasing monthly screening orders from 3,561 to 4,547 (p < 0.001). An administrative alert's firing frequency decreased by 86% through the introduction of a 4-hour lockout period, maintaining compliance rates. Finally, restricting a pediatric head circumference discrepancy alert to in-person visits only eliminated interruptions during telehealth encounters, addressing a major source of clinician frustration.

Conclusion

Aligning CDS tools with clinical workflows through adherence to the “Five Rights” framework reduces interruptions and improves outcomes. Iterative review, user feedback, and proactive redesign are essential to ensure CDS effectiveness, particularly as health care evolves to include novel care delivery models like telehealth.

Keywords

clinical decision support - alert fatigue - workflow

Volltext

Referenzen

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