Effectiveness Questioned
Even though hospitalists have witnessed a marked increase in visual warnings, there is little to suggest they are effective. For example, studies in Asia during the 2003 SARS scare suggest that isolation precautions were followed closely, yet there was no change in MRSA transmission rates.
The other concern is whether the saturation of warnings causes harm. Dr. Grace receives a warning flag on almost every chart requesting DVT prophylaxis—even for patients who are on heparin infusions or already are on prophylaxis. “Doctors get frustrated and start to ignore the [alerts],” he says. “Then, when someone slips through the cracks and doesn’t get needed treatment, we are less likely to catch it because of alert fatigue.”
Although they are the most visual, and perhaps the most frustrating, part of patient safety, warning signs are not the only bullets in the gunfight.
“I don’t think any institution views [warning] signs as the ultimate solution to problems,” Dr. Flanders says. “Signs end up being one part of a multifactorial intervention—a common and easy first piece of the puzzle.”
Warning signs in the hospital can serve an important communication function, alerting providers of key safety concerns. However, too many warnings can dilute the effectiveness of the signage and hinder patient care.
Hospitalists need to recognize the possibility of sign fatigue in their own practice and link warnings to truly high-risk situations. Alerts can be of help, but they should be viewed as a back-up—not a substitute—for good communication between physicians, colleagues, and the hospital staff. TH
Kurt Ullman is a freelance writer based in Indiana.