The DOI matches its Crossref record; 29 of the 29 references it cites were found in a registry or an index.
Effect of Computer-Based Alerts on the Treatment and Outcomes of Hospitalized Patients
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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“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]
In the citing paper
“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]
In the citing paper
“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]
Citations
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Computerized Display of Past Test Results
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Renal Effects of Ibuprofen, Piroxicam, and Sulindac in Patients with Asymptomatic Renal Failure
Whelton, A., Stout, R. L., Spilman, P. S., & Klassen, D. K. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-112-8-568 · Cited by 203
Physician Response to Computer Reminders
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Bates, D. W., & Gawande, A. A. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa020847 · Cited by 1,544
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van der Sijs, H., Aarts, J., Vulto, A., & Berg, M. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1809 · Cited by 1,117
Reducing the Frequency of Errors in Medicine Using Information Technology
Bates, D. W., Cohen, M., Leape, L. L., Overhage, J. M., Shabot, M. M., & Sheridan, T. (2001) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2001.0080299 · Cited by 959
Metadata
- 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)
- 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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