Well-designed electronic alerts improve care for cardiac patients

· News-Medical

But three Michigan Medicine studies suggest that well-designed alerts for critically ill cardiac patients can change what happens at the bedside, prompting clinicians to make recommended treatment decisions and recognize when patients are deteriorating.

Heart failure in the emergency department

Guidelines recommend giving acute decompensated heart failure patients at least twice the dose of diuretics they take at home when they arrive in the emergency department. However, the demands of a busy emergency department can make it challenging for clinicians to quickly review home medications and adjust diuretic therapy appropriately.

Using the alert did not delay treatment; the median time from arrival at the emergency department to diuretic dosing was roughly two hours in both groups.

"Our study did not assess whether following these digital alerts affected patient outcomes, such as fluid removal or length of hospital stay, but it does show that these tools are easily used in a clinical setting and affect treatment decisions," said Sarah Adie, Pharm.D., a clinical cardiology pharmacy specialist at U-M Health and author on all three studies.

"This is a critical first step toward broad clinical adoption in settings that treat critically ill cardiac patients."

Sedation in cardiac ICU

Another study examined sedation practices in more than 1,600 patients on a ventilator in the cardiac and medical intensive care units.

Nurses also reduced the continuous dose of commonly used sedatives - including fentanyl, propofol, midazolam and dexmedetomidine - in 23% of cases when the EHR generated an alert.

"The alerts are not designed to replace clinical judgment, rather they are a tool given at high pressure moments to assist clinicians with evidence-based guidance," said Anna Barker, M.D., Ph.D., a pulmonologist at University of Michigan Health who is senior author of the paper on light sedation.

Escalation of cardiogenic shock care

The third study examined how targeted alerts can help clinicians identify normotensive cardiogenic shock, which occurs when the heart cannot pump enough blood to the organs despite a patient having normal blood pressure.

Researchers implemented an EHR alert that identified patients who displayed additional physiological signs of normotensive cardiogenic shock and facilitated communication with a shock team in cardiac ICU.

Clinicians engaged with the alert in 14% of cases, and those encounters were linked with higher rates of cardiac ICU consultation within 12 hours.

Future of electronic health record alerts

Together, the three studies illustrate how targeted EHR alerts can assist clinicians across the continuum of critical cardiac care, from the emergency department to the cardiac ICU.

In one study, the tool offered patient-specific recommendations when the diuretic order was placed. In the two ICU studies, alerts prompted clinicians to limit deep sedation or to escalate shock cases to specialized critical care teams.

Researchers say the studies offer proof of concept, but more work must be done to ensure electronic alerts are beneficial without disrupting clinical workflow.

"Our next step is to evaluate these interventions across multiple health systems to better understand their impact on patient outcomes and determine how they can help improve the care of critically ill cardiac patients nationwide."

Source:

Michigan Medicine - University of Michigan

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