A Tool to Retrieve Alert Dwell Time from a Homegrown Computerized Physician Order Entry (CPOE) System of an Academic Medical Center: An Exploratory Analysis

Shuo-Chen Chien,Yen-Po Chin,Chun-You Chen,Yu-Chuan Li,Chang-Ho Yoon,Chia-Hui Chien,Chun-Kung Hsu

doi:10.3390/app112412004

Abstract

Alert dwell time, defined as the time elapsed from the generation of an interruptive alert to its closure, has rarely been used to describe the time required by clinicians to respond to interruptive alerts. Our study aimed to develop a tool to retrieve alert dwell times from a homegrown CPOE (computerized physician order entry) system, and to conduct exploratory analysis on the impact of various alert characteristics on alert dwell time. Additionally, we compared this impact between various professional groups. With these aims, a dominant window detector was developed using the Golang programming language and was implemented to collect all alert dwell times from the homegrown CPOE system of a 726-bed, Taiwanese academic medical center from December 2019 to February 2021. Overall, 3,737,697 interruptive alerts were collected. Correlation analysis was performed for alerts corresponding to the 100 most frequent alert categories. Our results showed that there was a negative correlation (ρ = −0.244, p = 0.015) between the number of alerts and alert dwell times. Alert dwell times were strongly correlated between different professional groups (physician vs. nurse, ρ = 0.739, p < 0.001). A tool that retrieves alert dwell times can provide important insights to hospitals attempting to improve clinical workflows.

Highlights

We successfully developed a dominant window detector using the Golang programming language, and retrieved alert dwell times in the homegrown computerized physician order entry (CPOE) system of an academic medical center in Taiwan
The alert log collector was implemented on 11 November 2017, in Wan Fang Hospital (WFH): in total, 3,737,697 triggered alerts were collected in the 14-month study period
Our study showed that more frequent alerts have lower alert dwell times, which may be suggestive of the phenomenon of alert fatigue existing in relation to our hospital’s current

Summary

Introduction

Interruptive alerts, in the form of suspended pop-up windows, have been widely used in clinical decision support (CDS) and computerized physician order entry (CPOE) systems to prevent medical errors during diagnosis and treatment [1,2,3]. Alert fatigue, defined as “the mental state that is the result of too many alerts consuming time and mental energy [11,12]”, usually occurs when interruptive alert systems unnecessarily and frequently distract clinicians from their thought processes [13]. Both clinically important and unimportant alerts may be ignored. Causes of alert fatigue include, but are not limited to: (1) a large number of alerts [14]; (2) clinically irrelevant alerts or alerts of low clinical value [15,16]; and (3) miscommunication or lack of communication of the meaning of the alert [17]

Methods

Results

Discussion

Conclusion