scholarly journals The tradeoffs between safety and alert fatigue: Data from a national evaluation of hospital medication-related clinical decision support

2020 ◽  
Vol 27 (8) ◽  
pp. 1252-1258 ◽  
Author(s):  
Zoe Co ◽  
A Jay Holmgren ◽  
David C Classen ◽  
Lisa Newmark ◽  
Diane L Seger ◽  
...  
Keyword(s):  
Clinical Decision ◽  
Evaluation Tool ◽  
Order Entry ◽  
Percentage Point Increase ◽  
Point Increase ◽  
Fatigue Data ◽  
Overall Performance ◽  
The Mean ◽  
The Cost ◽  
Physician Order Entry

Abstract Objective The study sought to evaluate the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in both 2017 and 2018, along with their performance against fatal orders and nuisance orders. Materials and Methods We evaluated 1599 hospitals that took the test in both 2017 and 2018 by using their overall percentage scores on the test, along with the percentage of fatal orders appropriately alerted on, and the percentage of nuisance orders incorrectly alerted on. Results Hospitals showed overall improvement; the mean score in 2017 was 58.1%, and this increased to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0% (P < .001), though there was almost no change in nuisance order performance (89.0% to 89.7%; P = .43). Hospitals alerting on one or more nuisance orders had a 3-percentage-point increase in their overall score. Discussion Despite the improvement of overall scores in 2017 and 2018, there was little improvement in fatal order performance, suggesting that hospitals are not targeting the deadliest orders first. Nuisance order performance showed almost no improvement, and some hospitals may be achieving higher scores by overalerting, suggesting that the thresholds for which alerts are fired from are too low. Conclusions Although hospitals improved overall from 2017 to 2018, there is still important room for improvement for both fatal and nuisance orders. Hospitals that incorrectly alerted on one or more nuisance orders had slightly higher overall performance, suggesting that some hospitals may be achieving higher scores at the cost of overalerting, which has the potential to cause clinician burnout and even worsen safety.

scholarly journals Do Strict Capital Requirements Raise the Cost of Capital? Bank Regulation, Capital Structure, and the Low-Risk Anomaly

2015 ◽  
Vol 105 (5) ◽  
pp. 315-320 ◽  
Author(s):  
Malcolm Baker ◽  
Jeffrey Wurgler
Keyword(s):  
Capital Structure ◽  
Stock Returns ◽  
Cost Of Capital ◽  
Weighted Average ◽  
Capital Requirements ◽  
Structure Theory ◽  
Treasury Bills ◽  
Percentage Point Increase ◽  
Point Increase ◽  
The Cost

Traditional capital structure theory predicts that reducing banks' leverage reduces the risk and cost of equity but does not change the weighted average cost of capital, and thus the rates for borrowers. We confirm that the equity of better-capitalized banks has lower beta and idiosyncratic risk. However, over the last 40 years, lower risk banks have not had lower costs of equity (lower stock returns), consistent with a stock market anomaly previously documented in other samples. A calibration suggests that a binding ten percentage point increase in Tier 1 capital to risk-weighted assets could double banks' risk premia over Treasury bills.

scholarly journals Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening

2009 ◽  
Vol 27 (32) ◽  
pp. 5370-5375 ◽  
Author(s):  
Veena Shankaran ◽  
Thanh Ha Luu ◽  
Narissa Nonzee ◽  
Elizabeth Richey ◽  
June M. McKoy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
New York ◽  
Cost Effectiveness ◽  
The United States ◽  
Sensitivity Analyses ◽  
Academic Detailing ◽  
Crc Screening ◽  
Percentage Point Increase ◽  
Point Increase ◽  
The Cost

Purpose Colorectal cancer (CRC) screening remains underutilized in the United States. Prior studies reporting the cost effectiveness of randomized interventions to improve CRC screening have not been replicated in the setting of small physician practices. We recently conducted a randomized trial evaluating an academic detailing intervention in 264 small practices in geographically diverse New York City communities. The objective of this secondary analysis is to assess the cost effectiveness of this intervention. Methods A total of 264 physician offices were randomly assigned to usual care or to a series of visits from trained physician educators. CRC screening rates were measured at baseline and 12 months. The intervention costs were measured and the incremental cost-effectiveness ratio (ICER) was derived. Sensitivity analyses were based on varying cost and effectiveness estimates. Results Academic detailing was associated with a 7% increase in CRC screening with colonoscopy. The total intervention cost was $147,865, and the ICER was $21,124 per percentage point increase in CRC screening rate. Sensitivity analyses that varied the costs of the intervention and the average medical practice size were associated with ICERs ranging from $13,631 to $36,109 per percentage point increase in CRC screening rates. Conclusion A comprehensive, multicomponent academic detailing intervention conducted in small practices in metropolitan New York was clinically effective in improving CRC screening rates, but was not cost effective.

P0180 APPLICATION OF A COMPUTERIZED SYSTEM FOR PHYSICIAN ORDER ENTRY WITH CLINICAL DECISION SUPPORT: PHARMACISTS INTERVENTIONS

2009 ◽  
Vol 20 ◽  
pp. S66
Author(s):  
Esther Duran Garcia ◽  
Carmen Rodriguez Gonzalez ◽  
N. Trovato Lopez ◽  
Maria Sanjurjo Saez ◽  
Maria Gomez Antúnez ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Order Entry ◽  
Physician Order Entry ◽  
Computerized System

scholarly journals A systematic analysis of the optimization of computerized physician order entry and clinical decision support systems: A qualitative study in English hospitals

2019 ◽  
Vol 26 (2) ◽  
pp. 1118-1132 ◽  
Author(s):  
Valeri Wiegel ◽  
Abby King ◽  
Hajar Mozaffar ◽  
Kathrin Cresswell ◽  
Robin Williams ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Extended Period ◽  
Clinical Decision ◽  
System Optimization ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Systematic Analysis ◽  
Physician Order Entry

This article analyzes the range of system optimization activities taking place over an extended period following the implementation of computerized physician order entry and clinical decision support systems. We undertook 207 qualitative semi-structured interviews, 24 rounds of non-participant observations of meetings and system use, and collected 17 organizational documents in five hospitals over three time periods between 2011 and 2016. We developed a systematic analysis of system optimization activities with eight sub-categories grouped into three main categories. This delineates the range of system optimization activities including resolving misalignments between technology and clinical practices, enhancing the adopted system, and improving user capabilities to utilize/further optimize systems. This study highlights the optimization efforts by user organizations adopting multi-user, organization-spanning information technologies. Hospitals must continue to attend to change management for an extended period (up to 5 years post-implementation) and develop a strategy for long-term system optimization including sustained user engagement, training, and broader capability development to ensure smoother and quicker realization of benefits.

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