Abstract

Objective

To identify and summarize the current internal governance processes adopted by hospitals, as reported in the literature, for selecting, optimizing, and evaluating clinical decision support (CDS) alerts in order to identify effective approaches.

Materials and methods

Databases (Medline, Embase, CINAHL, Scopus, Web of Science, IEEE Xplore Digital Library, CADTH, and WorldCat) were searched to identify relevant papers published from January 2010 to April 2020. All paper types published in English that reported governance processes for selecting and/or optimizing CDS alerts in hospitals were included.

Results

Eight papers were included in the review. Seven papers focused specifically on medication-related CDS alerts. All papers described the use of a multidisciplinary committee to optimize alerts. Other strategies included the use of clinician feedback, alert data, literature and drug references, and a visual dashboard. Six of the 8 papers reported evaluations of their CDS alert modifications following the adoption of optimization strategies, and of these, 5 reported a reduction in alert rate.

Conclusions

A multidisciplinary committee, often in combination with other approaches, was the most frequent strategy reported by hospitals to optimize their CDS alerts. Due to the limited number of published processes, variation in system changes, and evaluation results, we were unable to compare the effectiveness of different strategies, although employing multiple strategies appears to be an effective approach for reducing CDS alert numbers. We recommend hospitals report on descriptions and evaluations of governance processes to enable identification of effective strategies for optimization of CDS alerts in hospitals.

中文翻译：

---

优化电子病历中的临床决策支持警报：对医院采用的报告策略的系统评价

摘要

客观的

确定和总结医院目前采用的内部治理流程，如文献中所述，用于选择、优化和评估临床决策支持 (CDS) 警报，以确定有效方法。

材料和方法

检索了数据库（Medline、Embase、CINAHL、Scopus、Web of Science、IEEE Xplore 数字图书馆、CADTH 和 WorldCat）以识别 2010 年 1 月至 2020 年 4 月发表的相关论文。和/或优化医院的 CDS 警报。

结果

八篇论文被纳入审查。七篇论文专门针对与药物相关的 CDS 警报。所有论文都描述了使用多学科委员会来优化警报。其他策略包括使用临床医生反馈、警报数据、文献和药物参考以及可视化仪表板。8 篇论文中有 6 篇报告了对采用优化策略后 CDS 警报修改的评估，其中 5 篇报告了警报率的降低。

结论

多学科委员会通常与其他方法相结合，是医院报告的优化 CDS 警报的最常见策略。由于已发布的流程数量有限、系统变化的变化和评估结果，我们无法比较不同策略的有效性，尽管采用多种策略似乎是减少 CDS 警报数量的有效方法。我们建议医院报告治理过程的描述和评估，以便确定优化医院 CDS 警报的有效策略。