Top

Systematic Reviews

Published in:

Open Access 01-12-2017 | Protocol

Clinical reminder alert fatigue in healthcare: a systematic literature review protocol using qualitative evidence

Authors: Ruth Backman, Susan Bayliss, David Moore, Ian Litchfield

Published in: Systematic Reviews | Issue 1/2017

Abstract

Background

Integrated reminders within clinical systems have become more prevalent due to the use of electronic health records and evidence demonstrating an increase in compliance within practice. Clinical reminders are assessed for effectiveness on an individual basis, rather than in combination with existing prompts for other conditions. The growing number of prompts may be counter-productive as healthcare professionals are increasingly suffering from “reminder fatigue” meaning many reminders are ignored. This work will review the qualitative evidence to identify barriers and enablers of existing prompts found within computerised decision support systems. Our focus will be on primary care where clinicians have to negotiate a plethora of reminders as they deal with increasingly complex patients and sophisticated treatment regimes. The review will provide a greater understanding of existing systems and the way clinicians interact with them to inform the development of more effective and targeted clinical reminders.

Methods

A comprehensive search using piloted terms will be used to identify relevant literature from 1960 (or commencement of database) to 2017. MEDLINE, MEDLINE In Process, EMBASE, HMIC, PsycINFO, CDSR DARE, HTA, CINAHL and CPCI, will be searched, as well as grey literature and references and citations of included papers. Manuscripts will be assessed for eligibility, bias and quality using the CASP tool with narrative data being included and questionnaire based studies excluded. Inductive thematic analysis will be performed in order to produce a conceptual framework defining the key barriers around integrated clinical reminders.

Discussion

Indications of alert and reminder fatigue are found throughout the current literature. However, this has not been fully investigated using a robust qualitative approach, particularly in a rapidly growing body of evidence. This review will aid people forming new clinical systems so that alerts can be incorporated appropriately.

Systematic review registration

PROSPERO: CRD42016029418

Available only for authorised users

Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. J Contin Educ Heal Prof. [Internet]. 2004; 24 Suppl 1:S31-S37. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15712775 [cited 2016 Apr 5].

Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8:iii–v. 1-72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14960256 [cited 2015 Nov 25]CrossRefPubMed

Dexheimer JW, Talbot TR, Sanders DL, Rosenbloom ST, Aronsky D. Prompting clinicians about preventive care measures: a systematic review of randomized controlled trials. J Am Med Inform Assoc. 2008;15:311–20. Available from: http://www.sciencedirect.com/science/article/pii/S1067502708000170 [cited 2016 5]CrossRefPubMedPubMedCentral

Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;6:CD000259. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22696318 [cited 2015 Jun 29]

Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010:CD005470. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4164371&tool=pmcentrez&rendertype=abstract [cited 2015 Nov 25]

Brokel JM, Schwichtenberg TJ, Wakefield D, Ward M, Shaw M, Kramer JM. Evaluating clinical decision support rules as an intervention in clinician workflows with technology. CIN Comput Informatics, Nurs. 2011;29:36–42.CrossRef

Roland M, Everington S. Tackling the crisis in general practice. BMJ. 2016;352:i942. Available from: http://www.bmj.com/content/352/bmj.i942 [cited 2016 19]CrossRefPubMed

(mr) Web Master UK. Primary care [Internet]. (mr) Web Master, United Kingdom; [cited 2016 Feb 12]. Available from: http://www.hscic.gov.uk/primary-care.

Hughes LD, MET MM, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 42:62–9. Available from: http://ageing.oxfordjournals.org/content/42/1/62.full Oxford University Press; 2013 [cited 2016 12]

10.

Long Term Conditions Compendium of Information: Third Edition - Publications - GOV.UK [Internet]. [cited 2016 Feb 23]. Available from: https://www.gov.uk/government/publications/long-term-conditions-compendium-of-information-third-edition

11.

Grace A, Mahony C, O’Donoghue J, Heffernan T, Molony D, Carroll T. Evaluating the effectiveness of clinical decision support systems: the case of multimorbidity care. J Decis Syst. 2013;22

12.

Schedlbauer A, Prasad V, Mulvaney C, Phansalkar S, Stanton W, Bates DW, et al. What evidence supports the use of computerized alerts and prompts to improve clinicians’ prescribing behavior? J Am Med Inform Assoc. 2009;16:531–8. Available from: http://jamia.oxfordjournals.org/content/16/4/531.abstract [cited 2016 5]CrossRefPubMedPubMedCentral

13.

Litvin CB, Davis KS, Moran WP, Iverson PJ, et al. The Use of Clinical Decision-Support Tools to Facilitate Geriatric Education. J Am Geriatr Soc. 2012:1145–9. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=ovftm&NEWS=N&AN=00004495-201206000-00022

14.

Trevana L, McCaffery K, Salkeld G, Glasziou P, Mar C del, Doust J, et al. Clinical decision-making tools: how effective are they in improving the quality of health care? Fac. Heal. Sci. Med. Publ. 2014. Available from: http://epublications.bond.edu.au/hsm_pubs/861 [cited 2016 Feb 12].

15.

Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AGK, Clay C, et al. “Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med Inform Decis Mak. 2013;13 Suppl 2:S14. Available from: http://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-13-S2-S14 [cited 2015 Dec 29]CrossRefPubMed

16.

Ariza F, Kalra D, Potts HW. How do clinical information systems affect the cognitive demands of general practitioners?: usability study with a focus on cognitive workload. J Innov Heal Informatics. 2015;22:379–90. Available from: http://hijournal.bcs.org/index.php/jhi/article/view/85/857 [cited 2016 Feb 1]CrossRef

17.

Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson S-A. Computerized clinical decision support for prescribing: provision does not guarantee uptake. J Am Med Inform Assoc. 2010;17:25–33. Available from: http://jamia.oxfordjournals.org/content/17/1/25.abstract [cited 2016 Apr 5]CrossRefPubMedPubMedCentral

18.

Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS. Physicians’ decisions to override computerized drug alerts in primary care. Arch Intern Med. 2003;163:2625–31. Available from: http://archinte.jamanetwork.com/article.aspx?articleid=216364&resultclick=1 [cited 2016 Apr 5]CrossRefPubMed

19.

Kesselheim AS, Cresswell K, Phansalkar S, Bates DW, Sheikh A. Clinical decision support systems could be modified to reduce “alert fatigue” while still minimizing the risk of litigation. Health Aff (Millwood). 2011;30:2310–7. Available from: http://content.healthaffairs.org/content/30/12/2310.short [cited 2016 Feb 19]CrossRef

20.

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18616818 [cited 2016 Nov 24]CrossRefPubMedPubMedCentral

21.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. Available from: http://www.tandfonline.com/doi/abs/10.1191/1478088706qp063oa [cited 2016 Dec 12]CrossRef

22.

PRISMA [Internet]. [cited 2016 Feb 17]. Available from: http://www.prisma-statement.org/.

23.

Verboom B, Montgomery P, Bennett S. What factors affect evidence-informed policymaking in public health? Protocol for a systematic review of qualitative evidence using thematic synthesis. Syst Rev. 2016;5:61. Available from: http://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0240-6 [cited 2017 Feb 17]CrossRefPubMedPubMedCentral

24.

Noyes J, Popay J. Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-synthesis. J Adv Nurs. 2007;57:227–43. Available from: http://doi.wiley.com/10.1111/j.1365-2648.2006.04092.x [cited 2017 Feb 17]CrossRefPubMed

25.

Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013; Available from: http://doi.wiley.com/10.1002/14651858.CD010414.pub2 [cited 2017 Feb 17]

26.

Wong SS-L, Wilczynski NL, Haynes RB, Hedges Team. Developing optimal search strategies for detecting clinically relevant qualitative studies in MEDLINE. Stud Health Technol Inform. 2004;107:311–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15360825 [cited 2017 Feb 1]PubMed

27.

Critical Appraisal Skills Programme. CASP Qualitative Checklist [online] [Internet]. 2017 [cited 2017 Oct 23]. Available from: http://www.casp-uk.net/checklists.

28.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

29.

Dixon-Woods M, Shaw RL, Agarwal S, Smith JA. The problem of appraising qualitative research. Qual Saf Health Care. 2004;13:223–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15175495 [cited 2017 Feb 17]CrossRefPubMedPubMedCentral

30.

Carroll C, Booth A, Leaviss J, Rick J. “Best fit” framework synthesis: refining the method. BMC Med Res Methodol. 2013;13:37. Available from: http://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-13-37 [cited 2017 Feb 17]CrossRefPubMedPubMedCentral

31.

Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009;9:59. doi:10.1186/1471-2288-9-59.

32.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst. Rev. 2015;4:1. Available from: http://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1 [cited 2015 Jan 3]CrossRefPubMedPubMedCentral

33.

Booth A. "brimful of STARLITE": toward standards for reporting literature searches. J Med Libr Assoc. 2006;94:421–9. e205. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17082834 [cited 2017 Feb 17]PubMedPubMedCentral

34.

Moja L, Kwag KH, Lytras T, Bertizzolo L, Brandt L, Pecoraro V, et al. Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. Am J Public Health. 2014;104:e12–22. Available from: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302164 [cited 2016 Feb 13]CrossRefPubMedPubMedCentral

35.

Ranji SR, Rennke S, Wachter RM. Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ Qual Saf. 2014;23:773–80. Available from: http://qualitysafety.bmj.com/content/23/9/773 [cited 2015 Nov 1]CrossRefPubMed

36.

Nuckols TK, Smith-Spangler C, Morton SC, Asch SM, Patel VM, Anderson LJ, et al. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Syst. Rev. 2014;3:56. Available from: http://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-3-56 [cited 2015 Dec 21]CrossRefPubMedPubMedCentral

37.

Georgiou A, Prgomet M, Paoloni R, Creswick N, Hordern A, Walter S, et al. The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature. Ann Emerg Med. 2013;61:644–53. e16. Available from: http://www.annemergmed.com/article/S0196064413001005/fulltext [cited 2016 Feb 17]CrossRefPubMed

38.

Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L, et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003;10:523–30. Available from: http://jamia.oxfordjournals.org/content/10/6/523.abstract [cited 2015 Jul 13]CrossRefPubMedPubMedCentral

39.

Cresswell K, Majeed A, Bates DW, Sheikh A. Computerised decision support systems for healthcare professionals: an interpretative review. Inf Prim Care. 2012:115–28. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=ovftm&NEWS=N&AN=00151298-201220020-00006 [cited 2015 Dec 10]

Title: Clinical reminder alert fatigue in healthcare: a systematic literature review protocol using qualitative evidence
Authors: Ruth Backman
Susan Bayliss
David Moore
Ian Litchfield
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Systematic Reviews / Issue 1/2017
Electronic ISSN: 2046-4053
DOI: https://doi.org/10.1186/s13643-017-0627-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Clinical reminder alert fatigue in healthcare: a systematic literature review protocol using qualitative evidence

Abstract

Background

Methods

Discussion

Systematic review registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Discussion

Systematic review registration

Please log in to get access to this content

Other articles of this Issue 1/2017

Acceptance of a systematic review as a thesis: survey of biomedical doctoral programs in Europe

Evaluating overweight and obesity prevalence in survivors of childhood brain tumors: a systematic review protocol

Clinical, behavioural and pharmacogenomic factors influencing the response to levothyroxine therapy in patients with primary hypothyroidism—protocol for a systematic review

Effectiveness of current policing-related mental health interventions in England and Wales and Crisis Intervention Teams as a future potential model: a systematic review

Mobile tablet-based therapies following stroke: a systematic scoping review protocol of attempted interventions and the challenges encountered

The effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on longer-term maternal and early childhood outcomes: protocol for an individual participant data (IPD) meta-analysis