Differences among admitting departments in alerts and alert overrides for drug-drug interaction

Pharmacoepidemiol Drug Saf. 2014 Apr;23(4):390-7. doi: 10.1002/pds.3591. Epub 2014 Feb 21.


Objective: To determine differences in the incidence and risk factors of alerts for drug-drug interaction (DDI) and the rate of alert overrides by an admitting department.

Methods: A retrospective cohort study was performed using electronic health records of a Korean tertiary teaching hospital including all hospitalized adult patients for 18 months. The main outcome measures included incidence rates of alerts for DDI and their override, hazard ratios (HRs) for DDI alerts, and odds ratios (ORs) for alert overrides by admitting department (emergency department [ED], general ward [GW], and intensive care unit [ICU]) after adjusting for other known risk factors.

Results: Among 102 379 incident admissions, 6060 had alerts for DDI (5.4/person-year). After adjusting for covariates, patients admitted to the ED (HR, 4.02; confidence interval [CI], 3.69-4.38) or ICU (HR, 1.62; CI, 1.29-2.04) showed higher risks for DDI compared with those admitted to the GW. The alert-override rate was significantly higher in the ED (OR 1.68) than in the GW; however, there was no significant difference between GW and ICU. The prevalence of DDI alerts and their override rate were also demonstrated.

Discussion: The incidence of DDI and the alert-override rate differed by admitting department. The ED and ICU were associated with higher risks for alerts on DDI than did the GW after adjusting for other known risk factors.

Conclusions: Admitting department was an independent risk factor for alerts and alert overrides. Strategies to reduce alerts and alert overrides should consider the admitting department.

Keywords: clinical decision support systems; drug-drug interactions; electronic health records; pharmacoepidemiology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Admitting Department, Hospital / standards*
  • Adult
  • Aged
  • Cohort Studies
  • Decision Support Systems, Clinical*
  • Drug Interactions*
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Electronic Health Records
  • Female
  • Hospitals, Teaching
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Reminder Systems
  • Republic of Korea
  • Retrospective Studies
  • Risk Factors