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Laboratory alert fatigue erodes the effectiveness of clinical decision support by making repeated abnormal result notifications less likely to prompt timely clinical attention. It is often recognised only after providers begin delaying, overriding, or ignoring alerts. Current alert reduction strategies are commonly based on broad thresholds or blanket suppression rules. These approaches do not explain which providers, specialties, alert types, or repeated result patterns are most susceptible to fatigue. This article proposes an interpretable machine learning model that could predict whether a provider will exhibit fatigued behaviour toward a specific laboratory alert. The model is intended to support transparent, provider-aware alert redesign rather than opaque automation. The proposed framework would use historical alert logs with features capturing alert frequency, clinical severity, provider specialty, repeated abnormal results, response time history, and override behaviour. A regularised logistic regression or gradient-boosted tree model with SHAP explanations would provide both prediction and interpretability. Conceptually, the model would generate a fatigue risk score for each provider–alert pair. It would also attribute the score to specific drivers, such as repeated low-severity results, accumulated alert burden, or recent override patterns. An interpretable fatigue prediction model could enable personalised alert suppression, escalation, or redesign before a clinically important laboratory result is missed. Such a system would support safer, more adaptive clinical decision support.

Clinical pathways are designed to standardize inpatient care for common conditions while allowing clinically justified individualization. Deviations from these pathways are frequent and may reflect either appropriate adaptation to patient complexity or potentially harmful departure from evidence-informed practice. Current deviation detection often depends on retrospective audit, static compliance rules, or aggregate dashboards. These approaches can miss subtle temporal drift in care delivery and rarely explain why a specific patient trajectory diverged from the expected pathway. This article proposes an interpretable machine learning model for detecting clinical pathway deviations in hospitalized patients. The model focuses on order sequences, vital sign trends, laboratory monitoring frequency, and provider decision patterns as dynamic indicators of care-process variation. Conceptually, the model would compare each patient’s evolving care trajectory with learned expected pathways using sequence-comparison and outlier-detection logic. SHAP-based or attention-informed explanations would identify the specific features responsible for a deviation flag, such as delayed monitoring, omitted follow-up testing, or unusual ordering behavior. The proposed model could detect when a patient’s care trajectory diverges from an expected pathway and provide a transparent rationale for review. For example, it could flag a missing repeat troponin, a delayed antibiotic escalation, or a laboratory monitoring pattern inconsistent with the patient’s clinical state. An interpretable pathway-deviation model could shift quality monitoring from manual, sample-based review toward continuous and transparent pathway surveillance. Such a system would support real-time clinical awareness, structured audit, and organizational learning.