西西弗斯警告:改善静脉血栓塞栓症的艰苦斗争 预防 临床决策支持
Emily E Schildt1,2,3, Paul R Sutton2,3,4, Andrew F Lees5
1Department of Pediatrics, University of Washington, Seattle, Washington, United States.
Applied clinical informatics
|September 3, 2025
概括
对静脉血栓栓塞 (VTE) 化学预防的临床决策支持警报需要反复改进. 警报逻辑和用户反的故障凸显了持续优化的必要性,以确保有效的患者安全干预.
科学领域:
- 卫生信息学
- 患者安全
- 临床决策支持系统
背景情况:
- 在医院获得的静脉血栓塞栓症 (VTE) 是一个重要的风险,通常可以通过化疗预防.
- 在住院患者中,对静脉瘤化学预防的可靠订购仍然是一个挑战.
- 临床决策支持 (CDS) 系统旨在改善准则的遵守,但可能面临实施障碍.
研究的目的:
- 详细说明在开发和部署后优化中断性VTE化学预防的CDS警报时遇到的故障.
- 确定从VTE警报的代改进过程中吸取的经验教训.
- 分析VTE化学预防警报的性能和用户反.
主要方法:
- 在6个月的测试和16个月的部署中分析警报发射频率.
- 在代逻辑修改后对警报发射和解雇率的变化进行评估.
- 用户提交的关于警报性能和可用性的反的分类和专题分析.
主要成果:
- 在静音测试期间,中断警报最初每周发射超过11000次,在部署后显示持续高发射率 (每1000个患者日中53.8-61次).
- 尽管有修改,但没有下订单的警报被解雇率仍然很高,为88%.
- 消极用户反的主要原因 (近50%) 是"错误的人"发出警报,表明目标逻辑存在问题.
结论:
- 在VTE化疗警报中显示,未能满足CDS的"五项权利",因此需要持续的反改进.
- 高优先级安全警报的有效实施需要强有力的部署后监控和以用户为中心的优化.
- 应对警觉疲劳和确保临床医生准确的向对于成功的CDS干预措施来预防医院获得的VTE至关重要.
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