Clinical decision support a double-edged sword

Some patients are put off by doctors who use electronic decision-support tools during diagnostic visits, according to an article published recently in HealthLeaders Media. Nevertheless, a growing number of physicians rely on clinical decision support to inform their medical decisions, rather than run down the hall to check something in a textbook or the Physicians Desk Reference. After all, who can keep everything known about particular health conditions or drugs in their head?

In that regard, patients are wrong to assume that a doctor who doesn't use decision support is wiser than one who does. Some recent reports, however, indicate that the ever-increasing problem of alert fatigue can harm patients just as surely as a lack of knowledge.

A Boston Globe article, for example, found that "alarm fatigue" was related to 15 recent deaths in New England hospitals. In one case, clinicians failed to respond to a heart monitoring alert that sounded for more than an hour to warn of a low battery. After the battery finally died, so did the patient.

In another study of VA ambulatory-care clinics, clinicians said they received up to 150 alerts a day from their EHR. Checking them all out made it more difficult to respond to the most urgent alerts. Perhaps because of alert fatigue, providers did not even read 18 percent of alerts pertaining to abnormal imaging results, or 10 percent relating to abnormal laboratory tests.

For that reason, decision support remains a double-edged sword. In today's fast-paced healthcare environment, though, it's hard to see how doctors and nurses can do without it.

To learn more:
- read the HealthLeaders Media story
- check out this InformationWeek Healthcare piece about alarm fatigue
- here's another InformationWeek Healthcare piece about the VA study
- here's the abstract of that study 

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