Effectiveness of Interruptive Clinical Decision Support Alerts on Intravenous versus Oral Acetaminophen Prescribing
Year: 2026
Type: article
Study design: Clinical Trial
Abstract: Objective: Intravenous (IV) and oral acetaminophen have equivalent bioavailability and effectiveness, but IV formulations are significantly more expensive. Clinical decision support (CDS) tools can encourage cost-effective prescribing. We evaluated the effectiveness and acceptability of different CDS strategies on prescribing patterns of acetaminophen. Methods: We conducted a two-arm randomized controlled trial with a historical comparator at our academic medical center, including 23,676 acetaminophen orders for 13,139 adult inpatients between July 2023 and November 2024. In the preintervention period, providers received a single-click interruptive alert when ordering IV acetaminophen. In the postperiod, providers were randomized to either a multiclick interruptive alert or no alert. The primary outcome was alert effectiveness; secondary outcomes included acceptability and durability. Results: = 0.153). Among 624 interruptive alerts followed by orders, 24.5% switched to oral. Interrupted time series analysis showed no significant change in IV order trends. Conclusion: Approximately one-quarter of multiclick alerts prompted a switch to oral acetaminophen, but overall effectiveness was no greater than the control or single-click alert. Findings suggest that increasing alert disruptiveness may add cognitive burden without meaningful gains in effectiveness. A multiclick interruptive alert did not significantly change IV acetaminophen prescribing. Effective CDS strategies may require minimally disruptive designs integrated with education.
Source: Applied Clinical Informatics
DOI: 10.1055/a-2902-8381
Authors: Sara E. Booth, David M. Rubins, Ashley L. O'Donoghue, Steven Horng, Amy Miller, Lawrence J. Markson, Ryan Gould, Evan L. Leventhal, John Marshall, Jennifer P. Stevens
Institutions: Beth Israel Deaconess Medical Center, Harvard University
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7166170039