Alert burden in pediatric hospitals: A cross-sectional analysis of six academic pediatric health systems using novel metrics

Background: Excessive electronic health record (EHR) alerts reduce the
salience of actionable alerts. Little is known about the frequency of
interruptive alerts across health systems and how the choice of metric
affects which users appear to have the highest alert burden. Objective:
(1) Analyze alert burden by alert type, care setting, provider type, and
individual provider across 6 pediatric health systems. (2) Compare alert
burden using different metrics. Materials and Methods: We analyzed
interruptive alert firings logged in EHR databases at 6 pediatric health
systems from 2016-2019 using 4 metrics: (1) alerts per patient encounter,
(2) alerts per patient-day, (3) alerts per 100 orders, and (4) alerts per
unique clinician days (calendar days with at least one EHR log in the
system). We assessed intra- and inter-institutional variation and how
alert burden rankings differed based on the chosen metric. Results: Alert
burden varied widely across institutions, ranging from 0.06 to 0.76
firings per encounter, 0.22 to 1.06 firings per inpatient-day, 0.98 to
17.42 per 100 orders, and 0.08 to 3.34 firings per clinician day logged in
the EHR. Custom alerts accounted for the greatest burden at all 6 sites.
The rank order of institutions by alert burden was similar regardless of
which alert burden metric was chosen. Within institutions, the alert
burden metric choice substantially affected which provider types and care
settings appeared to experience the highest alert burden.
Conclusion: Estimates of the clinical areas with highest alert
burden varied substantially by institution and based on the metric used.