Interruptive clinical decision support systems, both within and outside of electronic health
records, are a resource that should be used sparingly and monitored closely. Excessive use of
interruptive alerting can quickly lead to alert fatigue and decreased effectiveness and ignoring of
alerts. In this review, we discuss the evidence for effective alert stewardship as well as practices
and methods we have found useful to assess interruptive alert burden, reduce excessive firings,
optimize alert effectiveness, and establish quality governance at our institutions. We also discuss
the importance of a holistic view of the alerting ecosystem beyond the electronic health record.
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In this panel, we will describe some of our most inglorious misfires as case vignettes in clinical decision support (CDS) implementation to share hard-earned lessons organized into 8 sociotechnical dimensions.
Estimates of the clinical areas with highest alert burden varied substantially by institution and based on the metric used.
We will discuss benefits and challenges in developing a pediatric learning collaborative for clinical decision support benchmarking and sharing of best practices, describe the strengths and weaknesses of different approaches to alert burden measurement, demonstrate how alert prioritization can inform quality improvement initiatives to reduce alert burden, examine unique measurement challenges for non-EHR alerts such as phone calls and text messages, and discuss strategies for linking alert burden analytics to governance strategies that facilitate improvement.