A quality improvement initiative to enhance the management of alerts and transmission-based precautions in the electronic health record

Abstract

Objective

To describe the redesign and implementation of an electronic alert management system aimed at supporting the identification and management of patients requiring transmission-based precautions in a high-complexity hospital.

Materials and methods

An organizational and technological intervention was carried out focusing on the revision of the alert workflow for patients at risk of transmitting microorganisms within the electronic health record system (HCIS). Standardized icons were designed for each type of precaution and integrated into bed maps and patient locator tools. A digital workflow was established allowing provisional alert activation by clinical or admission staff and subsequent validation by the Preventive Medicine Department. Alerts were automatically linked to a non-pharmacological prescription specifying the required precautionary measures, and a real-time locator system was developed. The evaluation was conducted through a descriptive before–after analysis across two six-month periods (2023–2024 and 2024–2025).

Results

A total of 1205 alerts were generated during both periods. Changes were described in the validation rates of provisional alerts and in the mean validation times, particularly for contact alerts.

Conclusions

The intervention allowed the reorganization and standardization of electronic alert management for transmission-based precautions, providing an organizational and technological framework that may be useful for other hospitals.

Resumen

Objetivo

Describir el rediseño e implantación de un sistema electrónico de gestión de alertas orientado a apoyar la identificación y el manejo de pacientes que requieren precauciones basadas en la transmisión en un hospital de alta complejidad.

Material y métodos

Se llevó a cabo una intervención organizativa y tecnológica centrada en la revisión del flujo de alertas para pacientes con riesgo de transmisión de microorganismos en el sistema de historia clínica electrónica (HCIS). Se diseñaron iconos estandarizados para cada tipo de precaución, integrados en mapas de camas y herramientas de localización de pacientes. Se estableció un flujo digital que permitió la activación provisional de alertas por parte del personal clínico o de admisión y su posterior validación por el Servicio de Medicina Preventiva. Las alertas se vincularon automáticamente a una prescripción no farmacológica con las medidas de precaución correspondientes y se desarrolló un sistema de localizadores en tiempo real. La evaluación se realizó mediante un análisis descriptivo antes–después en dos periodos de seis meses (2023–2024 y 2024–2025).

Resultados

During both periods, 1,205 alerts were generated. Changes were described in the validation rates of provisional alerts, and the average validation times were improved, especially for contact alerts.

Conclusiones

La intervención permitió reorganizar y estandarizar la gestión electrónica de alertas para precauciones basadas en la transmisión, aportando un marco organizativo y tecnológico que puede servir de referencia para otros hospitales.