A plethora of posters, a load of labels, and a rainbow of colored wristbands confront the average hospitalist every day. They serve as reminders to wash your hands, avoid using an extremity for blood draws, and other warnings both important and not so much. In this day and age, with a multitude of visual and technological reminders confronting physicians, some raise concerns about the consequences of too many reminders, also known as “alert fatigue.”
“The premise of [warning] signs is to improve quality,” says David Grace, MD, FHM, area medical officer for the Schumacher Group in Lafayette, La., and a member of Team Hospitalist. “I am not at all convinced that this is being accomplished. There is so much visual noise [in the hospital] that important messages get lost in the clutter.”
Alert fatigue is most often used to describe a phenomenon seen in computerized decision support systems. It’s the result of a physician receiving so many warnings that they grow numb and stop looking at them. Although it hasn’t been studied to the same extent in the low- or no-tech arena, alert fatigue is an issue in hospital-based signage.
Marilyn Sue Bogner, PhD, chief scientist at the Institute for the Study of Human Error, LLC, in Bethesda, Md., says alert oversaturation can have unintended consequences. “If there are too many signs, you really have no signs because people don’t pay attention,” she says. “I wouldn’t call it information overload, because you have to take information in before you can be overloaded.”
This lack of attention can lead to important information being ignored or misunderstood. It could cause serious disruptions in patient care and adverse outcomes, including the possibility of injury or even death.
Too Much of a Good Thing
One potentially harmful trend of warning signs in the hospital setting is what psychologists call “dilution.” The more warnings there are, the more people tend to lose sight of why the warning is there in the first place, and low-importance warnings “dilute” the strength of important ones.
“I would like to see a system where only truly high-risk patients are the ones who get the warnings,” Dr. Grace says. “If you restricted precautionary signs to those patients at high risk for transmitting something bad, or those at high risk for getting something bad, you would get better adherence than currently, where you seem to have signs for any patient with any risk for transmitting anything.”
For all the visual cues in the hospital setting to warn physicians of potential dangers, there exists no standardized system to help hospitalists sort out the direct patient-threats from the more mundane housekeeping chores.