{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T21:51:12Z","timestamp":1774475472508,"version":"3.50.1"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background Numerous programs have arisen to address interruptive clinical decision support (CDS) with the goals of reducing alert burden and alert fatigue. These programs often have standing committees with broad stakeholder representation, significant governance efforts, and substantial analyst hours to achieve reductions in alert burden which can be difficult for hospital systems to replicate.<\/jats:p><jats:p>\n          Objective\u2003This study aimed to reduce nursing alert burden with a primary nurse informaticist and small support team through a quality-improvement approach focusing on high-volume alerts.<\/jats:p><jats:p>\n          Methods\u2003Target alerts were identified from the period of January 2022 to April 2022 and four of the highest firing alerts were chosen initially, which accounted for 43% of all interruptive nursing alerts and an estimated 86\u2009hours per month of time across all nurses occupied resolving these alerts per month. Work was done concurrently for each alert with design changes based on the Five Rights of CDS and following a quality-improvement framework. Priority for work was based on operational engagement for design review and approval. Once initial design changes were approved, alerts were taken for in situ usability testing and additional changes were made as needed. Final designs were presented to stakeholders for approval prior to implementation.<\/jats:p><jats:p>\n          Results\u2003The total number of interruptive nursing alert firings decreased by 58% from preintervention period (1 January 2022\u201330 June 2022) to postintervention period (July 1, 2022\u2013December 31, 2022). Action taken on alerts increased from 8.1 to 17.3%. The estimated time spent resolving interruptive alerts summed across all nurses in the system decreased from 197\u2009hours\/month to 114\u2009hours\/month.<\/jats:p><jats:p>\n          Conclusion\u2003While CDS may improve use of evidence-based practices, implementation without a clear framework for evaluation and monitoring often results in alert burden and fatigue without clear benefits. An alert burden reduction effort spearheaded by a single empowered nurse informaticist efficiently reduced nursing alert burden substantially.<\/jats:p>","DOI":"10.1055\/a-2345-6475","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T23:34:26Z","timestamp":1718408066000},"page":"727-732","source":"Crossref","is-referenced-by-count":4,"title":["A Discount Approach to Reducing Nursing Alert Burden"],"prefix":"10.1055","volume":"15","author":[{"given":"Sarah A.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swaminathan","family":"Kandaswamy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan","family":"Orenstein","sequence":"additional","affiliation":[{"name":"Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States"},{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.7326\/0003-4819-157-1-201207030-00450","article-title":"Effect of clinical decision-support systems: a systematic review","volume":"157","author":"T J Bright","year":"2012","journal-title":"Ann Intern Med"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1001\/jama.293.10.1223","article-title":"Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review","volume":"293","author":"A X Garg","year":"2005","journal-title":"JAMA"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"742","DOI":"10.7326\/0003-4819-144-10-200605160-00125","article-title":"Systematic review: impact of health information technology on quality, efficiency, and costs of medical care","volume":"144","author":"B Chaudhry","year":"2006","journal-title":"Ann Intern Med"},{"issue":"02","key":"ref4","first-page":"187","article-title":"Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success","volume":"87","author":"E V Murphy","year":"2014","journal-title":"Yale J Biol Med"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1055\/s-0039-3402757","article-title":"Reducing interruptive alert burden using quality improvement methodology","volume":"11","author":"J D Chaparro","year":"2020","journal-title":"Appl Clin Inform"},{"key":"ref6","first-page":"26","article-title":"Some unintended consequences of clinical decision support systems","volume":"2007","author":"J S Ash","year":"2007","journal-title":"AMIA Annu Symp Proc"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1197\/jamia.M1809","article-title":"Overriding of drug safety alerts in computerized physician order entry","volume":"13","author":"H van der Sijs","year":"2006","journal-title":"J Am Med Inform Assoc"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1093\/jamia\/ocw072","article-title":"Alert override as a habitual behavior - a new perspective on a persistent problem","volume":"24","author":"M T Baysari","year":"2017","journal-title":"J Am Med Inform Assoc"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1136\/amiajnl-2011-000743","article-title":"Evaluating alert fatigue over time to EHR-based clinical trial alerts: findings from a randomized controlled study","volume":"19","author":"P J Embi","year":"2012","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1186\/s13643-017-0627-z","article-title":"Clinical reminder alert fatigue in healthcare: a systematic literature review protocol using qualitative evidence","volume":"6","author":"R Backman","year":"2017","journal-title":"Syst Rev"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s12911-017-0430-8","article-title":"Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system","volume":"17","author":"J S Ancker","year":"2017","journal-title":"BMC Med Inform Decis Mak"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1093\/jamia\/ocac027","article-title":"Clinician collaboration to improve clinical decision support: the Clickbusters initiative","volume":"29","author":"A B McCoy","year":"2022","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1055\/s-0039-3402715","article-title":"Reducing alert burden in electronic health records: state of the art recommendations from four health systems","volume":"11","author":"J D McGreevey III","year":"2020","journal-title":"Appl Clin Inform"},{"key":"ref14","volume-title":"When alerts work as expected but not as intended: situation awareness for patients with cardiac shunt at high risk of rapid deterioration","author":"S A Thompson","year":"2022"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"e138","DOI":"10.1093\/jamia\/ocv144","article-title":"Alert dwell time: introduction of a measure to evaluate interruptive clinical decision support alerts","volume":"23","author":"R B McDaniel","year":"2016","journal-title":"J Am Med Inform Assoc"},{"key":"ref16","doi-asserted-by":"crossref","DOI":"10.4324\/9781498757461","volume-title":"Improving Outcomes with Clinical Decision Support: An Implementer's Guide. 2nd ed","author":"J A Osheroff","year":"2012"},{"key":"ref17","volume-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed","author":"G J Langley","year":"2009"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1055\/s-0039-3402714","article-title":"Formative usability testing reduces severe blood product ordering errors","volume":"10","author":"E W Orenstein","year":"2019","journal-title":"Appl Clin Inform"},{"key":"ref19","doi-asserted-by":"crossref","DOI":"10.6028\/NIST.IR.7741","volume-title":"NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records","author":"R M Schumacher","year":"2010"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1093\/jamia\/ocx118","article-title":"Interface, information, interaction: a narrative review of design and functional requirements for clinical decision support","volume":"25","author":"K Miller","year":"2018","journal-title":"J Am Med Inform Assoc"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2345-6475.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T13:51:06Z","timestamp":1730814666000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2345-6475"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,14]]},"references-count":20,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2024,8,7]]},"published-print":{"date-parts":[[2024,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2345-6475","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,6,14]]},"published":{"date-parts":[[2024,6,14]]}}}