Integration of voice alerts to improve turnaround time for anticoagulation reversal

To evaluate the impact of electronic health record-integrated voice alerts on turnaround time for anticoagulation reversal agents across 6 hospitals within a health system.

This was a quasi-experimental pre-post study evaluating implementation of voice alerts for 4 reversal agents. Voice alerts were triggered when an eligible order entered the pharmacist verification queue. Six hospitals transitioned to the system on a staggered schedule. Orders were categorized into pre- and postimplementation periods, each spanning 90 days. Time from order signing to verification and administration were measured. Data were stratified by hospital, shift, and medication.

A total of 341 orders were analyzed, with 209 in the preimplementation period and 132 in the postimplementation period. During the postimplementation period, verification time decreased by 21.6% (P = 0.05) and administration time decreased by 20.8% (P < 0.01). Four out of 6 hospitals saw improvement in both verification and administration times. The largest turnaround time gains were for 4-factor prothrombin complex concentrate (4FPCC), which accounted for 73.3% of all orders. The largest verification time decrease (33.6%, P = 0.02) occurred during the night shift.

Voice alerts reduced turnaround time for high-priority anticoagulation reversal agents. The alerts were most impactful for 4FPCC and during the night shift, without requiring changes to existing pharmacy workflows. Site-specific implementation and alert routing were important in determining overall impact.