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Cited by 66Electronic Health Records SystemsOpioid Use Disorder TreatmentPatient Safety and Medication Errors

Clinically Inconsequential Alerts: The Characteristics of Opioid Drug Alerts and Their Utility in Preventing Adverse Drug Events in the Emergency Department

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Genco, Emma K., Forster, Jeri E., Flaten, Hanna, Goss, Foster, Heard, Kennon J., Hoppe, Jason, Monte, Andrew A.·2016·Annals of Emergency Medicine
DOI 10.1016/j.annemergmed.2015.09.020PMC PMC4955849
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Abstract

Study objective We examine the characteristics of clinical decision support alerts triggered when opioids are prescribed, including alert type, override rates, adverse drug events associated with opioids, and preventable adverse drug events. Methods This was a retrospective chart review study assessing adverse drug event occurrences for emergency department (ED) visits in a large urban academic medical center using a commercial electronic health record system with clinical decision support. Participants include those aged 18 to 89 years who arrived to the ED every fifth day between September 2012 and January 2013. The main outcome was characteristics of opioid drug alerts, including alert type, override rates, opioid-related adverse drug events, and adverse drug event preventability by clinical decision support. Results Opioid drug alerts were more likely to be overridden than nonopioid alerts (relative risk 1.35; 95% confidence interval [CI] 1.21 to 1.50). Opioid drug-allergy alerts were twice as likely to be overridden (relative risk 2.24; 95% CI 1.74 to 2.89). Opioid duplicate therapy alerts were 1.57 times as likely to be overridden (95% CI 1.30 to 1.89). Fourteen of 4,581 patients experienced an adverse drug event (0.31%; 95% CI 0.15% to 0.47%), and 8 were due to opioids (57.1%). None of the adverse drug events were preventable by clinical decision support. However, 46 alerts were accepted for 38 patients that averted a potential adverse drug event. Overall, 98.9% of opioid alerts did not result in an actual or averted adverse drug event, and 96.3% of opioid alerts were overridden. Conclusion Overridden opioid alerts did not result in adverse drug events. Clinical decision support successfully prevented adverse drug events at the expense of generating a large volume of inconsequential alerts. To prevent 1 adverse drug event, providers dealt with more than 123 unnecessary alerts. It is essential to refine clinical decision support alerting systems to eliminate inconsequential alerts to prevent alert fatigue and maintain patient safety.

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  • Alert burden can lead to high rates of alert overrides and physician burnout (both physical and cognitive).

    “Alert burden can lead to high rates of alert overrides and physician burnout (both physical and cognitive).9,16,64–66”

    From Electronic health record activity changes around new decision support implementation: monitoring using audit logs and topic modeling (2025) · cites this paper as [64]

    The Introduction (Background; page unavailable) says frequent, minimally significant warnings cause providers to repeatedly override alerts and reports high override rates. It calls this “alert fatigue,” but does not say alert burden causes physician burnout, physical or cognitive. (LLM, conf=0.88)

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Authors
Genco, E. K., Forster, J. E., Flaten, H., Goss, F., Heard, K. J., Hoppe, J., & Monte, A. A.
Affiliations
  • University of Colorado Anschutz (US)
  • VA Rocky Mountain Network (US)
Corresponding author
Genco, Emma K.
ORCID
Venue
Annals of Emergency Medicine
Publisher
Elsevier BV
Published
2016-02
Volume
67
Issue
2
Pages
240-248.e3
ISSN
0196-0644 (ISSN-L)
DOI
10.1016/j.annemergmed.2015.09.020
PMC
PMC4955849
OpenAlex
W2144579238
Cited by
66
References
39
Citations by year
2026: 5 · 2025: 10 · 2024: 6 · 2023: 10 · 2022: 6 · 2021: 6 · 2020: 6 · 2019: 5 · 2018: 4 · 2017: 4 · 2016: 4
FWCI
7.71
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Annals of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000154)
  • National Institute of General Medical Sciences (K23GM110516)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords
clinical decision support, alert override, adverse drug reactions, emergency department, alarm fatigue, drug allergy alerts, electronic health records, preventable adverse drug events, patient safety
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Analgesics, Opioid, Emergency Service, Hospital, Female, Humans, Male, Medication Errors, Middle Aged, Retrospective Studies, Adverse Drug Reaction Reporting Systems, Decision Support Systems, Clinical, Pharmacovigilance, Drug-Related Side Effects and Adverse Reactions

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