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Lewandowska K, Weisbrot M, Cieloszyk A, et al. Int J Environ Res Public Health. 2020;17:8409.
Alarm fatigue, which can lead to desensitization and threaten patient safety, is particularly concerning in intensive care settings. This systematic review concluded that alarm fatigue may have serious consequences for both patients and nursing staff. Included studies reported that nurses considered alarms to be burdensome, too frequent, interfering with patient care, and resulted in distrust in the alarm system. These findings point to the need for a strategy for alarm management and measuring alarm fatigue.  
Ruppel H, Liu V. BMJ Qual Saf. 2019;28:693-696.
Auditory warnings to flag patients at risk for sepsis can have unintended consequences, such as alert fatigue or distraction. Although heightened awareness of sepsis is crucial due to its potential for harm, the authors call for rigorous study and testing of these systems to reduce their negative effects. They highlight how recently published negative results illustrate the importance of designing sepsis alerting functions that are safe and effective. A WebM&M commentary discussed a case involving a misdiagnosis of sepsis.
Segal G, Segev A, Brom A, et al. J Am Med Inform Assoc. 2019;26:1560-1565.
Alerts designed to prevent inappropriate prescribing of medications are frequently overridden and contribute to alert fatigue. This study describes the use of machine learning to improve the clinical relevance of medication error alerts in the inpatient setting.
Hussain MI, Reynolds TL, Zheng K. J Am Med Inform Assoc. 2019;26:1141-1149.
This systematic review examined the override rates of several different clinical decision support approaches. Researchers conclude that role tailoring—the provision of different alerts to prescribers versus pharmacists—was the most successful method to reduce alert fatigue. They recommend redesigning decision support to reduce alert fatigue.
Dr. Saria is the John C. Malone Assistant Professor of computer science, statistics, and health policy at Johns Hopkins University. Her research focuses on developing next generation diagnostic, surveillance, and treatment planning tools to reduce adverse events and individualize health care for complex diseases. We spoke with her about artificial intelligence in health care.
Lifflander AL. JAMA. 2019;321:837-838.
Implementing new information systems can have unintended consequences on processes. This commentary explores insights from a physician, both as a clinician and as the family member of a patient, regarding the impact of hard stops in electronic health records intended to prevent gaps in data entry prior to task progression. The author raises awareness of the potential for patient harm due to interruptions and diminishing student and clinician skill in asking questions to build effective patient histories.
Gawande A. New Yorker. November 12, 2018.
In this magazine article, Atul Gawande describes a range of frustrations physicians experience as digitization becomes more widespread in health care. He elaborates upon several elements of electronic health record use that can degrade care processes and create conditions for errors, such as burnout, lack of patient-centeredness, and alert fatigue.
Knox R. Morning Edition. National Public Radio. January 27, 2014.
Reporting on alarm fatigue, this radio segment includes insights from a nurse manager and systems engineer and reveals how one hospital addressed the issue by removing low-level alerts and enabling nurses to customize alarm settings according to patient needs.
An epilepsy patient's discharge plan included phenytoin to be taken once daily. The prescribing physician was somewhat unfamiliar with the electronic medical record (EMR), didn't notice that the default frequency for phenytoin was "TID," and overrode the resultant computerized alert about the high dosage.
Baysari MT, Reckmann MH, Li L, et al. J Am Med Inform Assoc. 2012;19:1003-10.
Human factors engineering studies how users interact with technology and attempts to optimize systems to minimize unintended consequences in real-world usage. Computerized provider order entry (CPOE) systems offer considerable safety advantages, but in real-world situations, many CPOE systems have failed to achieve the anticipated results. This Australian study found that many clinicians did not use CPOE system features that were intended to improve efficiency and safety, possibly because doing so would have forced them to change their workflow substantially. This non-standard usage resulted in the generation of many clinically irrelevant alerts, likely contributing to alert fatigue and probably diminishing the overall safety performance of the system. The study highlights the need for usability testing and careful integration of new technology into existing clinician workflows.
Thinking that the patient's glycemic control had spontaneously improved (and not realizing that the patient was continuing to receive long-acting insulin injections), a physician discontinues daily glucose checks and insulin sliding scale orders. Four days later, the patient is found unresponsive and hypoglycemic.