Effect of Computer-Based Alerts on the Treatment and Outcomes of Hospitalized Patients

Rind, David M.

doi:10.1001/archinte.1994.00420130107014

Cited by 324Electronic Health Records SystemsHealthcare Technology and Patient MonitoringAcute Kidney Injury Research

Effect of Computer-Based Alerts on the Treatment and Outcomes of Hospitalized Patients

Rind, David M.·1994·Archives of Internal Medicine

DOI 10.1001/archinte.1994.00420130107014

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Abstract

BACKGROUND: Hospital computing systems play an important part in the communication of clinical information to physicians. We sought to determine whether computer-based alerts for hospitalized patients can affect physicians' behavior and improve patients' outcomes. METHODS: We performed a prospective time-series study to determine whether computerized alerts to physicians about rising creatinine levels in hospitalized patients receiving nephrotoxic or renally excreted medications led to more rapid adjustment or discontinuation of those medications, and to determine whether such alerts protected renal function. RESULTS: Laboratory data were observed for 20,228 hospitalizations, with documentation of 1573 events (instances of rising creatinine levels during treatment with a nephrotoxic or renally excreted drug). During the intervention period, doses were adjusted or medications discontinued an average of 21.6 hours sooner after such an event (P < .0001). For patients receiving nephrotoxic medications during the intervention period, the relative risk of serious renal impairment was 0.45 (95% confidence interval, 0.22 to 0.94) as compared with the control period, and the mean serum creatinine level was 14.1 mumol/L (0.16 mg/dL) lower on day 3 (P < .01) and 25.6 mumol/L (0.29 mg/dL) lower on day 7 (P < .05) after an event. Forty-four percent of physicians who responded to a questionnaire said that the alerts had been helpful in the care of their patients, whereas 28% found them annoying. Sixty-five percent wished to continue receiving alerts. CONCLUSIONS: Computer-based alerts regarding patients with rising creatinine levels affect physician behavior, prevent serious renal impairment, preserve renal function, and are accepted by clinicians.

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Interruptive alerts are a commonly used form of CDS and previous research has shown negative unintended consequences for end-users.
“Although it is difficult to quantify interruptive alert burden, they are a commonly used form of CDS, and previous research has shown negative unintended consequences for end-users.”
From Qualitative Study of Inpatient Hospital Medicine Interruptive Alerts and Clinical Decision Support (2026) · cites this paper as [1]
Electronic alerts have been shown to improve critical lab results communication in the inpatient setting.
“Electronic “alerts” have been shown to improve critical lab results communication in the inpatient setting, and they show promise in improving the safety of outpatient test result follow-up.45,52,53”
From Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology (2008) · cites this paper as [52]
Electronic alerts show promise in improving the safety of outpatient test result follow-up.
“Electronic “alerts” have been shown to improve critical lab results communication in the inpatient setting, and they show promise in improving the safety of outpatient test result follow-up.45,52,53”
From Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology (2008) · cites this paper as [52]

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Authors: Rind, D. M.
Affiliations: Harvard University (US)
Corresponding author: Rind, David M.
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 1994-07-11
Volume: 154
Issue: 13
Pages: 1511
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinte.1994.00420130107014
OpenAlex: W2011542177
Cited by: 323
References: 29
Citations by year: 2026: 1 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 5 · 2019: 6 · 2018: 5 · 2017: 9 · 2016: 14 · 2015: 12 · 2014: 10 · 2013: 7 · 2012: 10
FWCI: 30.14
Type: journal article
Language: en
Open access: closed
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Agency for Healthcare Research and Quality (HS06288-03)
Topics: Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords: nephrotoxic drugs, renal function, serum creatinine, medication dose adjustment, physician behavior, hospitalized patients, drug-induced nephrotoxicity, electronic health records
MeSH terms: Adult, Clinical Laboratory Information Systems, Creatinine, Drug Therapy, Computer-Assisted, Hospital Information Systems, Hospitalization, Humans, Office Automation, Prospective Studies, Surveys and Questionnaires, Linear Models, Treatment Outcome, Acute Kidney Injury

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Effect of Computer-Based Alerts on the Treatment and Outcomes of Hospitalized Patients

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