Because of poor design of electronic health records and medical systems, doctors, nurses and other clinicians routinely have to override warnings and alarms that have little relevance for patient care. While intended to make patients safer in theory, the proliferation of alerts may increase the chance patients will be harmed when an important warning is missed.
The average clinician sees “a staggering number of alerts” each day at work, making it too easy over time to spot the critical alarm from among the inconsequential ones, according to a primer by the Agency for Healthcare Resources and Quality (AHRQ). The consequences of this barrage of alerts is a “desensitization” that clinicians develop in order to cope, wrote Aaron E. Carroll, M.D., in a 2019 article in JAMA Forum.
“They start to ignore them because if everything causes an alert, then they stop having any real meaning,” Carroll wrote.
In a 2017 video posted by the Institute for Healthcare Improvement (IHI), Bob Wachter, M.D., of the University of California, San Francisco details the challenges in telling meaningful alerts from needless ones. At UCSF, doctors may see 30,000 alerts a month and pharmacists, 160,000 alerts.
“We touted alerts and alarms as being one of the main advantages of computerization,” Wachter said. “And I think right now, it’s a disaster.”
Wachter is among those who have urged a thorough reconsideration of the alerts clinicians see. For more on this, please see this WIRED series, based on Wachter’s “The Digital Doctor” book. It includes details of Wachter’s discussion with Boeing engineers about the strict standards that prevent airline pilots from being overwhelmed by alerts. The Joint Commission, which accredits hospitals, has repeatedly highlighted the risk of alarm fatigue, including making this a top priority among 2021 patient-safety goals. For a good recap of the state of efforts to address alert fatigue, see the “alarm fatigue” chapter in AHRQ’s Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices.