Appl Clin Inform 2019; 10(05): 909-917
DOI: 10.1055/s-0039-1700869
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Evaluating the Impact of Interruptive Alerts within a Health System: Use, Response Time, and Cumulative Time Burden

Pierre Elias
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
Eric Peterson
2  Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States
Bob Wachter
3  Department of Medicine, University of California, San Francisco, California, United States
Cary Ward
2  Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States
Eric Poon
4  Duke Health Technology Solutions, Duke University School of Medicine, Duke University, Durham, North Carolina, United States
Ann Marie Navar
2  Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States
› Author Affiliations
Further Information

Publication History

25 May 2019

19 September 2019

Publication Date:
27 November 2019 (online)


Background Health systems often employ interruptive alerts through the electronic health record to improve patient care. However, concerns of “alert fatigue” have been raised, highlighting the importance of understanding the time burden and impact of these alerts on providers.

Objectives Our main objective was to determine the total time providers spent on interruptive alerts in both inpatient and outpatient settings. Our secondary objectives were to analyze dwell time for individual alerts and examine both provider and alert-related factors associated with dwell time variance.

Methods We retrospectively evaluated use and response to the 75 most common interruptive (“popup”) alerts between June 1st, 2015 and November 1st, 2016 in a large academic health care system. Alert “dwell time” was calculated as the time between the alert appearing on a provider's screen until it was closed. The total number of alerts and dwell times per provider per month was calculated for inpatient and outpatient alerts and compared across alert type.

Results The median number of alerts seen by a provider was 12 per month (IQR 4–34). Overall, 67% of inpatient and 39% of outpatient alerts were closed in under 3 seconds. Alerts related to patient safety and those requiring more than a single click to proceed had significantly longer median dwell times of 5.2 and 6.7 seconds, respectively. The median total monthly time spent by providers viewing alerts was 49 seconds on inpatient alerts and 28 seconds on outpatient alerts.

Conclusion Most alerts were closed in under 3 seconds and a provider's total time spent on alerts was less than 1 min/mo. Alert fatigue may lie in their interruptive and noncritical nature rather than time burden. Monitoring alert interaction time can function as a valuable metric to assess the impact of alerts on workflow and potentially identify routinely ignored alerts.

Protection of Human and Animal Subjects

No human and/or animal subjects were included in the project. The research was limited to a retrospective review of de-identified data, and no personally identifiable information was collected.