Once-Per-Visit Alerts: A Means to Study Alert Compliance and Reduce Repeat Laboratory Testing

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Laboratory Medicine

Background:

• Clinical decision support (CDS) alerts for laboratory testing often face poor compliance.
• Once-per-visit alerts, triggered by repeat test orders within a single hospital admission, are specific for identifying potentially unnecessary laboratory orders.
• These alerts offer a valuable method for studying alert compliance in real-world clinical settings.

Purpose of the Study:

• To analyze compliance rates with once-per-visit laboratory testing alerts.
• To identify provider and test characteristics that correlate with alert compliance.
• To inform the design of future clinical decision support alerts for laboratory testing.

Main Methods:

• A retrospective analysis of once-per-visit alerts for 18 laboratory orderables was conducted over a 60-month period (September 2012 to October 2016).
• Data were collected from a 1200-bed academic medical center.
• Multivariate regression analysis was used to identify correlates of alert compliance, comparing alerts based on test and provider characteristics.

Main Results:

• Overall alert compliance was found to be 54.5%.
• Compliance was significantly correlated with several factors including length of stay at the time of the alert, provider type, prior alerts within the same patient visit, the specific test ordered, the total number of alerts experienced by the ordering provider, and the previous order status of the test.

Conclusions:

• Compliance with once-per-visit laboratory alerts is influenced by a variety of provider and test-specific characteristics.
• Future alert systems should integrate these identified characteristics into their design to enhance compliance and minimize alert overrides.
• Improving alert design is crucial for reducing unnecessary laboratory testing and optimizing clinical workflows.