ArticleJournal of the American Medical Informatics Association : JAMIA2020
The tradeoffs between safety and alert fatigue: Data from a national evaluation of hospital medication-related clinical decision support.
Article in Journal of the American Medical Informatics Association : JAMIA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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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.
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.
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2023Pooled it
- Risk Model-Guided Clinical Decision Support for Suicide Screening: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Effect of Electronic Health Record Clinical Decision Support on Contextualization of Care: A Randomized Clinical Trial.JAMA network open · 2022Trial
- Association of Hospital Public Quality Reporting With Electronic Health Record Medication Safety Performance.JAMA network open · 2021Trial
- Article
- Integrating clinical decision support systems, nursing vigilance, and physician prescribing patterns to reduce preventable adverse drug events: a structured evidence-based narrative review on human-AI interface in medication safety.Frontiers in digital health · 2026Review
- Alert Reduction and Telemonitoring Process Optimization for Improving Efficiency in Remote Patient Monitoring Programs: Framework Development Study.JMIR medical informatics · 2025Article
- Vulnerability of a New Zealand hospital computerised provider order entry system to prescribing error: a comparative study with other systems.Internal medicine journal · 2025Article
- Article
- A simulation study to quantitatively assess the performance of electronic prescribing systems in English NHS Hospital Trusts.Scientific reports · 2025Article
- Pharmacogenomic augmented machine learning in electronic health record alerts: A health system-wide usability survey of clinicians.Clinical and translational science · 2024Article
- Electronic Health Record Usability, Satisfaction, and Burnout for Family Physicians.JAMA network open · 2024Article
- Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- Early experiences of integrating an artificial intelligence-based diagnostic decision support system into radiology settings: a qualitative study.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Machine Learning and Artificial Intelligence Applications to Epilepsy: a Review for the Practicing Epileptologist.Current neurology and neuroscience reports · 2023Review
- How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool.Applied clinical informatics · 2023Article
- Non-Interruptive Clinical Decision Support to Improve Perioperative Electronic Positive Patient Identification.Journal of medical systems · 2022Observational
- Learning decision thresholds for risk stratification models from aggregate clinician behavior.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Evolution of Hematology Clinical Trial Adverse Event Reporting to Improve Care Delivery.Current hematologic malignancy reports · 2021Review
- The Development and Piloting of the Ambulatory Electronic Health Record Evaluation Tool: Lessons Learned.Applied clinical informatics · 2021Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectiveThe study sought to evaluate the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in both 2017 and 2018, along with their performance against fatal orders and nuisance orders. MATERIALS AND
methodsWe evaluated 1599 hospitals that took the test in both 2017 and 2018 by using their overall percentage scores on the test, along with the percentage of fatal orders appropriately alerted on, and the percentage of nuisance orders incorrectly alerted on.
resultsHospitals showed overall improvement; the mean score in 2017 was 58.1%, and this increased to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0% (P < .001), though there was almost no change in nuisance order performance (89.0% to 89.7%; P = .43). Hospitals alerting on one or more nuisance orders had a 3-percentage-point increase in their overall score. DISCUSSION: Despite the improvement of overall scores in 2017 and 2018, there was little improvement in fatal order performance, suggesting that hospitals are not targeting the deadliest orders first. Nuisance order performance showed almost no improvement, and some hospitals may be achieving higher scores by overalerting, suggesting that the thresholds for which alerts are fired from are too low.
conclusionsAlthough hospitals improved overall from 2017 to 2018, there is still important room for improvement for both fatal and nuisance orders. Hospitals that incorrectly alerted on one or more nuisance orders had slightly higher overall performance, suggesting that some hospitals may be achieving higher scores at the cost of overalerting, which has the potential to cause clinician burnout and even worsen safety.
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Registered trials
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.