Care Team Alerts

Provision of Clinical Alerts to Non-Physician Care Providers and Supervisors

Scenario Details:  Bobby is a young man admitted to the intensive care unit for septic shock.  He is ventilated, on intravenous medication for hypotension and sepsis, and is being monitored aggressively by the ICU team.  Around noon, Bobby’s morning labs are resulted and his platelet count is determined to be 40, a critical value.

The platelet result triggers several knowledge modules; one ensures that the care team is notified as appropriate. Initially, the module sends a page to the ordering provider and a notification alert to both the bedside terminal and the system account of Bobby’s nurse, Sue. 

Unfortunately, Sue is in radiology with another patient. Had Sue needed to access the system, she would have been notified of Bobby’s alert, but she had no opportunity or reason to do so. The alert causes the bedside terminal to start flashing red, indicating the patient had an critical alert requiring attention, but Sue’s cross-cover was busy and the color-coded screen saver went unnoticed.

After 10 minutes, the lack of alert acknowledgement triggers an escalation. This time the unit attending is paged and the central nursing station computer also begins flashing red. The charge nurse instantly see the alert from across the station, logs in to identify the patient needing attention, and goes to the bedside where she acknowledges the alert and begins her assessment.

The charge nurse’s acknowledgement “silences” the alert for all who received a notification, hiding it from the view of all recipients EXCEPT those intended to receive it originally. In those accounts, the alert is acknowledged, but remains in view, optionally grouped/sorted by patient or priority. 

The attending physician never receives the page as intended. He sees an alert notification in his task bar several hours later, just about the same time he gets a phone call from the hospital risk manager informing him of the critical alert he failed to respond to. He reviews the alert logic and his hospital contact information and makes a quick update to his pager number that was inaccurate.

Upon returning from radiology and before getting report from the cross-cover, Sue sees the acknowledged alert in her task/alert listing and reads the associated assessment note. She is relieved that Bobby was promptly assessed and makes note of the fact that, as per protocol, the platelet count was being reviewed for clumping by pathology.

Bobby is later discharged and the system automatically clears his alerts, except for one that has explicit provisions for transferring workflow to the outpatient setting. In this case, the system recommended a follow-up platelet count two weeks after discharge. This recommendation message is transferred directly to the outpatient provider.

Actors: Ordering provider, attending provider, bedside terminal (scheduled/cross-over nurse), scheduled nurse, unit attending, central nursing station terminal (charge nurse), Patient (Bobby)

Requirements:[FA1]