Hospitals have been using electronic alerts on doctor's computers in recent years as a way to improve the quality of care, with mixed results. Doctors often ignore the warnings - some experts blame "alert fatigue." Cedars-Sinai Medical Center has been trying to refine the strategy.
Since late 2013, Cedars-Sinai has used guidelines from the Choosing Wisely initiative created by the American Board of Internal Medicine. The guidelines lay out 18 different alerts designed to help providers avoid unnecessary treatments, tests and medications.
A preliminary review of how doctors reacted to the alerts in the hospital’s computer system shows positive results, according to Cedars. The patients of doctors who followed the guidelines had fewer complications, spent less time in the hospital and had lower rates of readmission.
"In many cases the chances of missing something is far smaller than the chances of causing harm in trying to follow up on a test that ... really wasn’t clinically relevant," says Dr. Harry Sax, Cedars' vice chair of surgery.
Noting that patients often pressure doctors to conduct unnecessary tests, he says the electronic intervention can prompt providers to have those conversations with patients and their families.
In most cases, doctors have the option to follow the recommendation, make a change, justify a different course of action or ignore the alert altogether.
Some Cedars providers are still ignoring alerts, says Sax. The hospital's initial analysis found that those doctors' patients have a greater risk of complications and higher readmission rates. He says the next step is to explore why some providers follow the alerts and some don't.