Evidence map›Paper›PMID 29092059›Full record

Observational studyJournal of the American Medical Informatics Association : JAMIA2018

Medication-related clinical decision support alert overrides in inpatients.

Karen C Nanji, Diane L Seger, Sarah P Slight, Mary G Amato, Patrick E Beeler, Qoua L Her, Olivia Dalleur, Tewodros Eguale, Adrian Wong, Elizabeth R Silvers and 6 more

Open access · bronzeAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of the American Medical Informatics Association : JAMIA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 1 pooled it
16.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 1 synthesis or guideline pooled it, 162 citations in OpenAlex.

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22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 7 institutions in 3 countries.

Karen C NanjiDepartment of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Diane L SegerPartners HealthCare Systems, Wellesley, MA, USA.
Sarah P SlightThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Mary G AmatoThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Patrick E BeelerThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Qoua L HerThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Olivia DalleurThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Tewodros EgualeThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Adrian WongThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Elizabeth R SilversPartners HealthCare Systems, Wellesley, MA, USA.
Michael SwerdloffPartners HealthCare Systems, Wellesley, MA, USA.
Salman T HussainDepartment of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Nivethietha ManiamPartners HealthCare Systems, Wellesley, MA, USA.
Julie M FiskioThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Patricia C DykesThe Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
David W BatesHarvard Medical School, Boston, MA, USA.
Brigham and Women's Hospital · USNational Patient Safety Foundation · USHarvard University · USMass General Brigham · USCliniques Universitaires Saint-Luc · BEMassachusetts General Hospital · USNewcastle University · GB

Funding

Health Information Technology Center for Education and Research on Therapeutics *U19HS021094 · AHRQ · BRIGHAM AND WOMEN'S HOSPITAL · PI BATES, DAVID W., MD,MSC · 2011 to 2015
$4.1M
Preventing Perioperative Medication Errors and Adverse Drug Events Through the Use of Clinical Decision SupportK08HS024764 · AHRQ · MASSACHUSETTS GENERAL HOSPITAL · PI NANJI, KAREN C · 2016 to 2020
$793k
AHRQ HHS K08 HS024764AHRQ HHS U19 HS021094
6 · The paper itself

Abstract

Objective: To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers' reasons for overriding them and the appropriateness of those reasons. Materials and Methods: We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons. Results: Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P < .0001). About 60% of overrides were appropriate, and that proportion also varied by alert type (P < .0001). Few overrides of renal- (2.2%) or age-based (26.4%) medication substitutions were appropriate, while most duplicate drug (98%), patient allergy (96.5%), and formulary substitution (82.5%) alerts were appropriate. Discussion: Despite warnings of potential significant harm, certain categories of alert overrides were inappropriate >75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue. Conclusion: Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.

Indexed as

Decision Support Systems, ClinicalDrug Therapy, Computer-AssistedMedical Order Entry SystemsAlert Fatigue, Health PersonnelCross-Sectional StudiesDrug HypersensitivityDrug InteractionsHumansMeaningful Use

Identifiers

PMID29092059
PMCPMC7646870
OpenAlexW2765920053

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.