Clinical Decision Support
Chapter 12 Bedside Questions · 9 questions · about 9 minutes
Alert libraries accumulate without owners, review or removal, fire outside the workflow with assessments instead of recommendations, and are not aimed at the deadliest orders. Clinicians reflexively override, and the one alert that matters is missed. The failure is governance and prioritization, not software.
CDS as the hospital’s reflexes, a knee jerk that must be calibrated; and alerts as the boy who cried wolf until the listener stopped listening.
Answer as your executive team would, with the evidence in hand. Each question has a factual answer in a system you already own.
What is your alert override rate, by alert and in aggregate; who reports it and who is accountable?
Add a note: where is the evidence, or who owns it?
Sorted by consequence, what fraction of alert volume fires on orders that could seriously harm vs. could not?
Add a note: where is the evidence, or who owns it?
Do you have a chartered committee with explicit authority to deactivate an alert; name the last alert it retired.
Add a note: where is the evidence, or who owns it?
When was the library last reviewed in its entirety against current evidence?
Add a note: where is the evidence, or who owns it?
What proportion of alerts deliver a recommendation rather than an assessment?
Add a note: where is the evidence, or who owns it?
Do alerts fire at the moment of decision or downstream of it?
Add a note: where is the evidence, or who owns it?
Have recent safety events been mapped back to the CDS that should have prevented them?
Add a note: where is the evidence, or who owns it?
Who owns the integrated experience across native rules, third-party engines and model-driven support?
Add a note: where is the evidence, or who owns it?
For every alert firing more than a thousand times a month, is there a physician sponsor?
Add a note: where is the evidence, or who owns it?
A reflection tool from the book, not a validated diagnostic test or benchmark. Your answers and notes stay in this browser unless you choose to send them. Please don't enter patient information.
What is missing is a chartered committee, and a Diagnostician with the authority to turn things off.
The Diagnostician, Chapter 12