A pilot for automated pages from the EHR: Improving time between active restraint orders in the pediatric intensive care unit

<b>Introduction:</b> Pediatric restraint orders require frequent renewal to ensure patient safety. Previously, providers depended on nurses paging them upon order expiration, leading to lapses. <b>Methods:</b> In April 2023, we implemented an alerting system in our 38-bed pediatric intensive care unit (PICU) that sent automated text messages to providers upon order expiration. Pediatric wards and adult ICU served as controls. We analyzed 2 years of restraint order data. An unpaired t-test compared pre- and post-intervention. <b>Results:</b> A total of 1394 orders were included (133 PICU, 628 pediatric wards, 633 adult ICU). In the PICU, time without an active order decreased by 39% (2 h 23 min to 1 h 27 min, <i>p</i> = .24) though this result did not reach statistical significance. <b>Conclusion:</b> Despite not reaching statistical significance, this exploratory case study demonstrated that automated EHR alerts may reduce time without an active restraint order. This pilot led the institution's informatics team to system-wide adoption. While promising, such systems must be balanced against risks like provider alarm fatigue.