Top 5 videos from HIMSS17

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Top 5 videos from HIMSS17

Mayo Clinic physician proposes smart system to curb alert fatigue

Vitaly Herasevich, MD, bases the idea on the “failure to rescue,” concept that started in the nursing field and is gaining traction in applied clinical informatics. 
By John Andrews
07:28 AM
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Mayo Clinic alert fatigue

Vitaly Herasevich, MD, said most alarms in place today are simple but often ineffective. 

When clinicians are getting annoyed by an overabundance of alerts, it is time to ascertain why the problem exists and plan a strategy for fixing it.

And not only is "alarm overload" a prevalent issue – it is listed as the number one health technology hazard by the Emergency Care Research Institute.

Vitaly Herasevich, MD, associate professor of anesthesiology and medicine at the Mayo Clinic, attributes the proliferation of alerts to the massive influx of technologies available to clinicians.

The primary goal of the clinical alert is to indicate that some parameter or process failed outside the intended range.

“Most alerts use a threshold-based approach to fire it,” he said. “Very simple, but often it is ineffective.”

To illustrate the point, Herasevich uses a traffic light analogy: It regulates traffic with two intended conditions – go and stop. However, it uses three colors – red, yellow and green.

“It looks like a two-staged process which still needs more than two stages in alerting to safely regulate the process,” he said. “Alarms have a direct impact on clinicians by contributing to information overload, and that is the primary driver for an alarm hazard.”

One solution to the over-alerting situation is to develop a “smart” alert system, such as the “failure to rescue” concept, originating from the nursing field and recently translated to applied clinical informatics.

“The idea in this context is to issue an alert only in a situation when clinical providers fail to do the intended action,” Herasevich said. “For example, administering insulin if a patient’s blood sugar is high. Instead of sending an alert that the blood sugar is high, the smart system checks if insulin was already ordered and given in a specific amount of time. If not, only then is the alert issued. That simple approach dramatically decreases unnecessary alerts while easing the cognitive load and increasing satisfaction with the IT system.”

He cautioned, however, that “this type of alert is not appropriate in life-threatening situations, where traditional ‘hard wired’ real-time alerts must be maintained.”

In his HIMSS17 program “Smart Alerts in Healthcare: Real as Never Before,” Herasevich will spell out why the “alarm overload” situation exists and offer some key steps for addressing it. The session is scheduled for Thursday Feb. 23, at 10:30 a.m. in Room 207C. 

HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.


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