4 ms·

This is exactly it--nurses are usually not empowered to set alarm thresholds or delays, but physicians are. So, docs ask for the most sensitive settings they ca

This is exactly it--nurses are usually not empowered to set alarm thresholds or delays, but physicians are. So, docs ask for the most sensitive settings they can (because they want that intimacy of care), but they're gone 15 minutes later and the rest of the unit has to deal with the fallout for the rest of the day.

maddog99 12y ago
Not sure what "intimacy of care" means, but most docs, like me, are frustrated and annoyed by the barrage of wolf-crying that comes out of these systems, of which Epic is one of the best and best-designed. (So far, all the others I've seen are FAR worse.) I WANT to see the meaningful alerts, but it's difficult to do with a sea of identical-appearing utter BS. Besides alert fatigue, there's a related problem with cognitive load. For this patient, I want to order A, B, C, and D. Now erect roadblocks in front of A, B, and C, and quite often D will fall by the wayside. By the way, I've never been able to set or even influence the alert policy. This was mandated by corporate risk management, whose policy appears always to be more alerts = safer.
- angersock 12y ago
  We've seen alarm policies range from "Dr. X wants this to be the threshold on the patient" to "Unit policy is X, change during a PDSA cycle someday" to "Eh, this seems alright for this patient" to "silence as many alarms as reasonable". I'm sympathetic to "it's corporate's fault", but instead of fixing that problem I see a lot of folks lobbying for shiny new toys, meetings to stroke egos, and basically spending their political capital on being prima donnas instead of making their lives easier from an operations standpoint--and for the rest of the docs such as yourself this obviously is a problem. :( The roadblocks bit is what it is--if doctors were better at prescribing medications and hadn't cowed their colleagues and nurses into a culture of "oh, well, I shouldn't say anything" then automated systems wouldn't be so compelling from a safety standpoint. As it is, they are undermined continually (as explained in this article) by the humans who have to work with them and who--as you've exemplified--don't trust them. Let's face it: in the next 30 years, most physicians who are basically knowledge workers are going to be doing work very differently than they are today, most of it with heavy computerized assistance. You can choose which side of history you want to be on.

maddog99 12y ago

Not sure what "intimacy of care" means, but most docs, like me, are frustrated and annoyed by the barrage of wolf-crying that comes out of these systems, of which Epic is one of the best and best-designed. (So far, all the others I've seen are FAR worse.) I WANT to see the meaningful alerts, but it's difficult to do with a sea of identical-appearing utter BS. Besides alert fatigue, there's a related problem with cognitive load. For this patient, I want to order A, B, C, and D. Now erect roadblocks in front of A, B, and C, and quite often D will fall by the wayside. By the way, I've never been able to set or even influence the alert policy. This was mandated by corporate risk management, whose policy appears always to be more alerts = safer.

angersock 12y ago
We've seen alarm policies range from "Dr. X wants this to be the threshold on the patient" to "Unit policy is X, change during a PDSA cycle someday" to "Eh, this seems alright for this patient" to "silence as many alarms as reasonable". I'm sympathetic to "it's corporate's fault", but instead of fixing that problem I see a lot of folks lobbying for shiny new toys, meetings to stroke egos, and basically spending their political capital on being prima donnas instead of making their lives easier from an operations standpoint--and for the rest of the docs such as yourself this obviously is a problem. :( The roadblocks bit is what it is--if doctors were better at prescribing medications and hadn't cowed their colleagues and nurses into a culture of "oh, well, I shouldn't say anything" then automated systems wouldn't be so compelling from a safety standpoint. As it is, they are undermined continually (as explained in this article) by the humans who have to work with them and who--as you've exemplified--don't trust them. Let's face it: in the next 30 years, most physicians who are basically knowledge workers are going to be doing work very differently than they are today, most of it with heavy computerized assistance. You can choose which side of history you want to be on.