"A few years ago, while assigned to help out in the emergency department, he was listening to the ambulance report on a patient who'd just arrivedan elderly woman with dangerously low blood pressurewhen a sepsis flag flashed in the hospital's electronic system. Sepsis, a life-threatening response to infection, is a major cause of death in U.S. hospitals, and early treatment is critical. The flag prompted the charge nurse to instruct Hart to room the patient immediately, take her vitals and begin intravenous (IV) fluids."
"But when Hart examined the woman, he saw that she had a dialysis catheter below her collarbone. Her kidneys weren't keeping up. A routine flood of IV fluids, he warned, could overwhelm her system and end up in her lungs. The charge nurse told him to do it anyway because of the sepsis alert generated by the hospital's artificial-intelligence system. Hart refused."
"A physician overheard the escalating conversation and stepped in. Instead of fluids, the doctor ordered dopamine to raise the patient's blood pressure without adding volumeaverting what Hart believed could have led to a life-threatening complication. What stayed with Hart was the choreography that the AI-generated alert produced. A screen prompted urgency, which a protocol turned into an order; a bedside objection grounded in clinical reasoning landed, at least in the moment, as defiance."
An electronic sepsis alert triggered rapid, protocol-driven orders to administer IV fluids in the emergency department. The attending nurse identified a dialysis catheter and failing kidneys and warned that a fluid bolus could cause pulmonary edema. The charge nurse insisted on fluids because of the AI-generated alert; the bedside nurse refused. A physician intervened and ordered dopamine to raise blood pressure without adding volume, avoiding a potentially life-threatening complication. The incident shows how algorithmic alerts can prompt urgency and pressure to comply, potentially overriding patient-specific clinical judgment and risking harm.
Read at www.scientificamerican.com
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