Alert Overrides: The Impact of Chained Events

1. Hunt, D.L., et al., Effects of computer-based clinical decision support systems on physician performance and patient outcomes. JAMA, 1998. 280(15): p. 13391346. 2. Kuperman, G.J., et al., Medication-related clinical decision support in computerized provider order entry systems: a review.JAMIA, 2007. 14(1): p. 29-40. 3. Phansalkar, S., et al., A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems. JAMIA, 2010. 17(5): p. 493-501. 4. Van Der Sijs, H., et al., Overriding of drug safety alerts in computerized physician order entry. JAMIA, 2006. 13(2): p. 138-147. • Override rates were calculated, based on clinician response to alerts, in two formats: isolates and chains. • Chained alerts were defined as multiple alerts occurring with less than a 60 second gap between notifications for the same user. • Alert chains were grouped in three categories, short, medium and long, according to their length (Fig 1) . • For each chained alert, we identified their position, classified them by chain segment and calculated the override rates for each group (Fig 2) .