Sisyphus' Alert: The Uphill Struggle to Improve Venous Thromboembolism Prophylaxis Clinical Decision Support

Applied Clinical Informatics · 2025-08-01

Chemoprophylaxis reduces the risk of hospital-acquired venous thromboembolism (VTE), but is not reliably ordered. Our institution created a clinical decision support (CDS) interruptive alert to remind clinicians to order VTE chemoprophylaxis when it is missing for qualifying inpatients. Unfortunately, this alert has required repeated modifications to ensure accurate logic, and continues to generate negative feedback from users.This study aimed to describe multiple failures in the development and postdeployment optimization of this interruptive alert, and our lessons learned.This study analyzed the number of times this alert fired over 6 months of testing and 16 months of deployment, and changes in either the frequency of alert firing or the frequency of the alert being dismissed without orders placed with iterative changes in the alert logic. Feedback about this alert was compiled and classified into common themes.The initial alert fired an average of 11,154 times per week when tested silently, prompting significant refinements before release. The alert shown to users fired an average of 53.8 times per 1,000 patient days in the first 6 months of the study period. Despite postlaunch improvements, this rose to 61 alerts per 1,000 patient days in the final 6 months of the study. Modifications also did not cause a significant decrease in how frequently the alert was dismissed without further action being taken (88%). Review of narrative feedback and its classification highlights "wrong person" receiving the alert being by far the most prevalent cause for negative submitted user feedback (nearly 50%), despite efforts to develop logic that limits firing to the patient's primary team.Changes to this VTE alert were summarized as failures to meet the "five rights" of CDS. Alerts for high-priority safety issues require persistent feedback-driven improvement, particularly when there is poor performance or negative user experience.

ATS Workshop 2024

CERN Document Server (European Organization for Nuclear Research) · 2024-01-01

<!--HTML-->The Mechanical and Engineering support section of the Cryogenics group (TE-CRG-ME) is heavily involved in the design, production, installation and commissioning of a wide range of cryogenic devices and systems for the experiments, accelerators and test facilities at CERN. To increase the efficiency of our work and improve the standardization to the norms, calculations and methods used for development, a Cryogenic Engineering Tool Kit has been developed. This presentation will review the main contents of the toolkit and the importance of these methods to TE CRG ME.

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review

Academic Medicine · 2023 · 9 citations

• Medical education
• Medicine
• Psychology

PURPOSE: This study systematically reviews the uses of electronic health record (EHR) data to measure graduate medical education (GME) trainee competencies. METHOD: In January 2022, the authors conducted a systematic review of original research in MEDLINE from database start to December 31, 2021. The authors searched for articles that used the EHR as their data source and in which the individual GME trainee was the unit of observation and/or unit of analysis. The database query was intentionally broad because an initial survey of pertinent articles identified no unifying Medical Subject Heading terms. Articles were coded and clustered by theme and Accreditation Council for Graduate Medical Education (ACGME) core competency. RESULTS: The database search yielded 3,540 articles, of which 86 met the study inclusion criteria. Articles clustered into 16 themes, the largest of which were trainee condition experience (17 articles), work patterns (16 articles), and continuity of care (12 articles). Five of the ACGME core competencies were represented (patient care and procedural skills, practice-based learning and improvement, systems-based practice, medical knowledge, and professionalism). In addition, 25 articles assessed the clinical learning environment. CONCLUSIONS: This review identified 86 articles that used EHR data to measure individual GME trainee competencies, spanning 16 themes and 6 competencies and revealing marked between-trainee variation. The authors propose a digital learning cycle framework that arranges sequentially the uses of EHR data within the cycle of clinical experiential learning central to GME. Three technical components necessary to unlock the potential of EHR data to improve GME are described: measures, attribution, and visualization. Partnerships between GME programs and informatics departments will be pivotal in realizing this opportunity.

Writing Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study (Preprint)

2021

• Computer Science
• Computer Science
• Political Science

<sec> <title>BACKGROUND</title> Hospital progress notes can serve as an important communication tool. However, they are criticized for their length, preserved content, and for the time physicians spend writing them. </sec> <sec> <title>OBJECTIVE</title> We aimed to describe hospital progress note content, writing and reading practices, and the preferences of those who create and read them prior to the implementation of a new electronic health record system. </sec> <sec> <title>METHODS</title> Using a sample of hospital progress notes from 1000 randomly selected admissions, we measured note length, similarity of content in successive daily notes for the same patient, the time notes were signed and read, and who read them. We conducted focus group sessions with note writers, readers, and clinical leaders to understand their preferences. </sec> <sec> <title>RESULTS</title> We analyzed 4938 inpatient progress notes from 418 authors. The average length was 886 words, and most were in the Assessment &amp;amp; Plan note section. A total of 29% of notes (n=1432) were signed after 4 PM. Notes signed later in the day were read less often. Notes were highly similar from one day to the next, and 26% (23/88) had clinical risk associated with the preserved content. Note content of the highest value varied according to the reader’s professional role. </sec> <sec> <title>CONCLUSIONS</title> Progress note length varied widely. Notes were often signed late in the day when they were read less often and were highly similar to the note from the previous day. Measuring note length, signing time, when and by whom notes are read, and the amount and safety of preserved content will be useful metrics for measuring how the new electronic health record system is used, and can aid improvements. </sec>

Writing Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study

Journal of Medical Internet Research · 2021 · 10 citations

• Computer Science
• Sociology
• Psychology

BACKGROUND: Hospital progress notes can serve as an important communication tool. However, they are criticized for their length, preserved content, and for the time physicians spend writing them. OBJECTIVE: We aimed to describe hospital progress note content, writing and reading practices, and the preferences of those who create and read them prior to the implementation of a new electronic health record system. METHODS: Using a sample of hospital progress notes from 1000 randomly selected admissions, we measured note length, similarity of content in successive daily notes for the same patient, the time notes were signed and read, and who read them. We conducted focus group sessions with note writers, readers, and clinical leaders to understand their preferences. RESULTS: We analyzed 4938 inpatient progress notes from 418 authors. The average length was 886 words, and most were in the Assessment & Plan note section. A total of 29% of notes (n=1432) were signed after 4 PM. Notes signed later in the day were read less often. Notes were highly similar from one day to the next, and 26% (23/88) had clinical risk associated with the preserved content. Note content of the highest value varied according to the reader's professional role. CONCLUSIONS: Progress note length varied widely. Notes were often signed late in the day when they were read less often and were highly similar to the note from the previous day. Measuring note length, signing time, when and by whom notes are read, and the amount and safety of preserved content will be useful metrics for measuring how the new electronic health record system is used, and can aid improvements.

相対的オフタイム削減におけるOpicaponeオッズ比:BIPARK-IとIIの組合せデータからの事後解析【JST・京大機械翻訳】

Journal of the Neurological Sciences · 2019-01-01

The analysis of C9orf72 repeat expansions in a large series of clinically and pathologically diagnosed cases with atypical parkinsonism (vol 36, 1221.e1, 2015)

UCL Discovery (University College London) · 2015-04-01

Analysis of sprint swimming: the 50m freestyle

2013-02-01 · 2 citations

SPG11 sequencing in worldwide populations of familial and sporadic spastic paraplegia patients reveals frequent mutations and the common association of parkinsonian features

UCL Discovery (University College London) · 2013-06-01