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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3067 — Reducing Overload from CPRS View Alerts: How do We Know What’s Really Necessary?

Murphy DR (Houston HSRD Center of Excellence), Kadiyala H (Michael E. DeBakey VAMC), Hirani K (Michael E. DeBakey VAMC), Reis BA (Houston HSRD Center of Excellence), Singh H (Houston HSRD Center of Excellence)

Objectives:
Communication in the VA outpatient setting is highly dependent on the CPRS View Alert notification system. This system “alerts” primary care providers (PCPs) to their patients’ test results and referral status, as well as when other providers transmit them messages through additional signature requests (ASR alerts). We previously found that PCPs miss certain high-priority notifications related to abnormal test results and referrals. While PCPs report receiving large volumes of alerts, little research exists to determine which alerts are potentially unnecessary. To identify alerts that could be amenable to future reduction strategies, we tested a methodology to ascertain the utility of ASR alerts and determined the proportion that was potentially unnecessary.

Methods:
We accessed a centralized “Alert Tracking File” at our local facility and identified ASR alerts transmitted to PCPs between June 2009 and January 2010. On a randomly selected 1% sample, two full-time PCPs with experience in quality-improvement methods performed independent chart reviews to determine alert necessity. Reviewers rated each alert on three attributes: (1) subjective importance (2) urgency for follow-up action, if any, and (3) harm that might occur if the alert was missed. To improve specificity, if reviewers disagreed on a rating, the rating that signified higher importance, urgency, or potential harm was used for analysis. Because ASR alerts link to progress notes, we also evaluated what proportion of each note contained PCP-relevant information.

Results:
Of 420,927 total alerts we accessed, 53,606 (12.7%) were identified as ASR alerts, of which 536 were reviewed. The majority (95.3%) were important to at least one reviewer (81.6% inter-rater agreement) and 78.4% were determined to require a PCP action within one week. Potential for at least minor harm existed in 74.0% alerts if information they contained was missed. On average, only 19.4% of each note was determined to be actually relevant.

Implications:
Provider-to-provider messages in CPRS constitute a significant proportion of View Alerts and communicate important information to PCPs.

Impacts:
Strategies to help providers manage high alert volumes may need to focus on improving alert flow, such as routing certain alerts to other care team members or highlighting text relevant to ASR alert recipients.


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