The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.
A Clinical Case of Electronic Health Record Drug Alert Fatigue: Consequences for Patient Outcome
Abstract
Despite advances in electronic medication order entry systems, it has been well established that clinicians override many drug allergy alerts generated by the electronic health record. The direct clinical consequences of overalerting clinicians in a pediatric setting have not been well demonstrated in the literature. We observed a patient in the PICU who experienced complications as a result of an extended series of non–evidence-based alerts in the electronic health record. Subsequently, evidence-based allergy alerting changes were made to the hospital’s system. Incorporating clinical evidence in electronic drug allergy alerting systems remains challenging, especially in pediatric settings.
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In the citing paper
“It is widely accepted that “alert fatigue” explains high override rates [7, 9–14].”
From Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system (2017) · cites this paper as [9]
In the citing paper
“A second conceptual model of alert fatigue is that repeated exposure to alerts leads to declining responsiveness [9, 19, 20], a phenomenon that can be called desensitization .”
From Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system (2017) · cites this paper as [9]
In the citing paper
“Application of AI systems in the real world may lead to many unintended outcomes, including alert fatigue,131 additional burdens for clinicians, disruption of interpersonal communications, and generation of specific threats requiring increased vigilance to recognize.132”
From Artificial intelligence in diabetes management: Advancements, opportunities, and challenges (2023) · cites this paper as [131]
Citations
Cites
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Improving Safety with Information Technology
Bates, D. W., & Gawande, A. A. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa020847 · Cited by 1,544
Data-driven prediction of drug effects and interactions
Tatonetti, N. P., Ye, P. P., Daneshjou, R., & Altman, R. B. (2012) · Science Translational Medicine · doi:10.1126/scitranslmed.3003377 · Cited by 936
Physicians' Decisions to Override Computerized Drug Alerts in Primary Care
Weingart, S. N., Toth, M., Sands, D. Z., Aronson, M. D., Davis, R. B., & Phillips, R. S. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.21.2625 · Cited by 487
Improving Acceptance of Computerized Prescribing Alerts in Ambulatory Care
Shah, N. R., Seger, A. C., Seger, D. L., Fiskio, J. M., Kuperman, G. J., Blumenfeld, B., Recklet, E. G., Bates, D. W., & Gandhi, T. K. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1868 · Cited by 353
Absence of Cross-Reactivity between Sulfonamide Antibiotics and Sulfonamide Nonantibiotics
Strom, B. L., Schinnar, R., Apter, A. J., Margolis, D. J., Lautenbach, E., Hennessy, S., Bilker, W. B., & Pettitt, D. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022963 · Cited by 349
Horsky, J., Schiff, G. D., Johnston, D., Mercincavage, L. M., Bell, D. S., & Middleton, B. (2012) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2012.09.002 · Cited by 307
Kesselheim, A. S., Cresswell, K., Phansalkar, S., Bates, D. W., & Sheikh, A. (2011) · Health Affairs · doi:10.1377/hlthaff.2010.1111 · Cited by 277
Schedlbauer, A., Prasad, V., Mulvaney, C., Phansalkar, S., Stanton, W., Bates, D. W., & Avery, A. J. (2009) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2910 · Cited by 262
Hsieh, T. C., Kuperman, G. J., Jaggi, T., Hojnowski-Diaz, P., Fiskio, J., Williams, D. H., Bates, D. W., & Gandhi, T. K. (2004) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1556 · Cited by 232
Cited by
Sorted by citations
Artificial intelligence in healthcare
Yu, K.-H., Beam, A. L., & Kohane, I. S. (2018) · Nature Biomedical Engineering · doi:10.1038/s41551-018-0305-z · Cited by 2,817
with the HITEC Investigators, Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-017-0430-8 · Cited by 709
Artificial intelligence in diabetes management: Advancements, opportunities, and challenges
Guan, Z., Li, H., Liu, R., Cai, C., Liu, Y., Li, J., Wang, X., Huang, S., Wu, L., Liu, D., et al. (2023) · Cell Reports Medicine · doi:10.1016/j.xcrm.2023.101213 · Cited by 287
Recommendations to improve the usability of drug-drug interaction clinical decision support alerts
Payne, T. H., Hines, L. E., Chan, R. C., Hartman, S., Kapusnik-Uner, J., Russ, A. L., Chaffee, B. W., Hartman, C. A., Tamis, V., Galbreth, B., et al. (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv011 · Cited by 193
Artificial intelligence-based clinical decision support in pediatrics
Ramgopal, S., Sanchez-Pinto, L. N., Horvat, C. M., Carroll, M. S., Luo, Y., & Florin, T. A. (2022) · Pediatric Research · doi:10.1038/s41390-022-02226-1 · Cited by 187
Metadata
- Authors
- Carspecken, C. W., Sharek, P. J., Longhurst, C., & Pageler, N. M.
- Affiliations
- Harvard University (US)
- Lucile Packard Children's Hospital (US)
- Systems Medicine, and
- Stanford Medicine (US)
- ORCID
- Pageler, Natalie M.
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2013-06-01
- Volume
- 131
- Issue
- 6
- Pages
- e1970-e1973
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2047955590
- Cited by
- 142
- References
- 22
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 9 · 2023: 11 · 2022: 11 · 2021: 10 · 2020: 15 · 2019: 11 · 2018: 8 · 2017: 11 · 2016: 11 · 2015: 17 · 2014: 8 · 2013: 2
- FWCI
- 21.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Medicine › Pharmacology (medical) › Drug-Induced Adverse Reactions
- Keywords
- drug allergy alerts, electronic health records, alarm fatigue, alert override, pediatric intensive care unit, drug safety, patient outcomes
- MeSH terms
- Child, Preschool, Diagnosis, Differential, Drug Hypersensitivity, Fatigue, Humans, Male, Medication Errors, Practice Patterns, Physicians', Evidence-Based Medicine, Decision Support Systems, Clinical, Medical Order Entry Systems, Electronic Health Records
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