Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting

PeerJ. 2017;5:e3083 DOI 10.7717/peerj.3083

 

Journal Homepage

Journal Title: PeerJ

ISSN: 2167-8359 (Online)

Publisher: PeerJ Inc.

LCC Subject Category: Medicine

Country of publisher: United States

Language of fulltext: English

Full-text formats available: PDF, HTML, XML

 

AUTHORS

Andrew M. Harrison (Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States of America)
Charat Thongprayoon (Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States of America)
Christopher A. Aakre (Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America)
Jack Y. Jeng (Mayo Medical School, Mayo Clinic, Rochester, MN, United States of America)
Mikhail A. Dziadzko (Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States of America)
Ognjen Gajic (Division of Pulmonology and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America)
Brian W. Pickering (Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States of America)
Vitaly Herasevich (Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States of America)

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 10 weeks

 

Abstract | Full Text | Full Text

Background Electronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored. Objective To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system. Study Design In one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview. Results The alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148) and 51% (N = 156) from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5) and median 2 min (N = 80) from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers. Conclusion Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting.