Clinician perspectives on electronic health record behavioral alerts and hospital workplace violence prevention: A mixed methods study at 20 organizations.

Background: Workplace violence prevention programs are important for safety, but little is known about how they are perceived by clinicians or whether electronic health record (EHR) behavioral alerts are perceived as effective.

Objective: To understand perspectives on the use of EHR behavioral alerts as part of workplace violence prevention programs in hospitals.

Methods: Mixed methods study utilizing semi-structured focus groups with a structured survey. Focus group participants were members of a national hopsitalist consortium.

Results: Twenty-eight individuals from 20 different organizations participated in focus groups, with 24 (86%) completing the survey. There was broad uncertainty in best practices for inpatient workplace violence prevention. There was also wide variation in EHR behavioral alert use across multiple domains, including how and why the alerts are placed and how they are used by the end user. Finally, focus groups had mixed sentiments on the potential impacts of these alerts; among participants who responded to surveys, half (50%) noted that alerts caused deviations in care and 21% indicated they witnessed instances where behavioral alerts led to adverse patient outcomes. Most (67%) survey respondents did not think EHR behavioral alerts prevented workplace violence. The majority (88%) of respondents also reported that patient demographic factors impacted whether an alert was placed.

Limitations: The study focused on clinician experience at academic hospitals.

Conclusions and relevance: Reports of uncertainty in best practices for deploying EHR behavioral alerts, along with perceptions of variability in implementation and potential biases in alert usage, raise concerns about their effectiveness and potential for worsening disparities. Standardized, evidence-based practices that safeguard healthcare workers without compromising patient care and equity are needed.