Eliminating Safety Clutter in a Safety-Net Hospital

Effective governance of interruptive alerts in the electronic health record (EHR) is critical to ensure use that maximizes value and minimizes burden. This type of governance can be difficult in under-resourced safety-net settings. The aim of this initiative was to strengthen EHR alert governance, with a goal of reducing staff time spent in interruptive alerts without increasing patient harm.

At a large, urban safety-net hospital, work was led by a systemwide Alerts Committee, comprised of registered nurses, pharmacists, physicians and advanced practice providers (APPs), informatics, quality staff, and EHR analysts. Iterative application of a safety clutter framework was conducted to address low-value interruptive alerts. Steps included discovering clutter, refining infrastructure, and removing clutter.

The authors identified and deimplemented 15 low-value interruptive alerts intended to promote patient safety. This led to a 48.6% reduction in staff time spent in interruptive alerts and more reliable action on remaining alerts, with no increase in adverse safety events. Subsequent improvement cycles included spread of these steps to practices outside of the EHR.

Safety clutter was a valuable framework in a way that was feasible and effective in a safety-net environment. Staff voice is key to eliminating safety clutter and administrative harm.