Effectiveness of a clinical decision support system for reducing the risk of qt interval prolongation in hospitalized patients

James E. Tisdale, Heather A. Jaynes, Joanna R. Kingery, Brian R. Overholser, Noha A. Mourad, Tate N. Trujillo, Richard Kovacs

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background-We evaluated the effectiveness of a computer clinical decision support system (CDSS) for reducing the risk of QT interval prolongation in hospitalized patients. Methods and Results-We evaluated 2400 patients admitted to cardiac care units at an urban academic medical center. A CDSS incorporating a validated risk score for QT<inf>c</inf> prolongation was developed and implemented using information extracted from patients' electronic medical records. When a drug associated with torsades de pointes was prescribed to a patient at moderate or high risk for QT<inf>c</inf> interval prolongation, a computer alert appeared on the screen to the pharmacist entering the order, who could then consult the prescriber on alternative therapies and implement more intensive monitoring. QT<inf>c</inf> interval prolongation was defined as QT<inf>c</inf> interval <500 ms or increase in QT<inf>c</inf> of =60 ms from baseline; for patients who presented with QT<inf>c</inf> <500 ms, QT <inf>c</inf> prolongation was defined solely as increase in QT<inf>c</inf> =60 ms from baseline. End points were assessed before (n=1200) and after (n=1200) implementation of the CDSS. CDSS implementation was independently associated with a reduced risk of QT<inf>c</inf> prolongation (adjusted odds ratio, 0.65; 95% confidence interval, 0.56-0.89; P>0.0001). Furthermore, CDSS implementation reduced the prescribing of noncardiac medications known to cause torsades de pointes, including fluoroquinolones and intravenous haloperidol (adjusted odds ratio, 0.79; 95% confidence interval, 0.63-0.91; P=0.03). Conclusions-A computer CDSS incorporating a validated risk score for QT <inf>c</inf> prolongation influences the prescribing of QT-prolonging drugs and reduces the risk of QT<inf>c</inf> interval prolongation in hospitalized patients with torsades de pointes risk factors. (Circ Cardiovasc Qual Outcomes. 2014;7:381-390.)

Original languageEnglish
Pages (from-to)381-390
Number of pages10
JournalCirculation: Cardiovascular Quality and Outcomes
Volume7
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Clinical Decision Support Systems
Torsades de Pointes
Odds Ratio
Confidence Intervals
Electronic Health Records
Fluoroquinolones
Haloperidol
Complementary Therapies
Pharmacists
Pharmaceutical Preparations

Keywords

  • Computer-assisted
  • Electrocardiography
  • Medical decision making
  • Risk score
  • Torsades de pointes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Effectiveness of a clinical decision support system for reducing the risk of qt interval prolongation in hospitalized patients. / Tisdale, James E.; Jaynes, Heather A.; Kingery, Joanna R.; Overholser, Brian R.; Mourad, Noha A.; Trujillo, Tate N.; Kovacs, Richard.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 7, No. 3, 2014, p. 381-390.

Research output: Contribution to journalArticle

Tisdale, James E. ; Jaynes, Heather A. ; Kingery, Joanna R. ; Overholser, Brian R. ; Mourad, Noha A. ; Trujillo, Tate N. ; Kovacs, Richard. / Effectiveness of a clinical decision support system for reducing the risk of qt interval prolongation in hospitalized patients. In: Circulation: Cardiovascular Quality and Outcomes. 2014 ; Vol. 7, No. 3. pp. 381-390.
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AU - Jaynes, Heather A.

AU - Kingery, Joanna R.

AU - Overholser, Brian R.

AU - Mourad, Noha A.

AU - Trujillo, Tate N.

AU - Kovacs, Richard

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N2 - Background-We evaluated the effectiveness of a computer clinical decision support system (CDSS) for reducing the risk of QT interval prolongation in hospitalized patients. Methods and Results-We evaluated 2400 patients admitted to cardiac care units at an urban academic medical center. A CDSS incorporating a validated risk score for QTc prolongation was developed and implemented using information extracted from patients' electronic medical records. When a drug associated with torsades de pointes was prescribed to a patient at moderate or high risk for QTc interval prolongation, a computer alert appeared on the screen to the pharmacist entering the order, who could then consult the prescriber on alternative therapies and implement more intensive monitoring. QTc interval prolongation was defined as QTc interval <500 ms or increase in QTc of =60 ms from baseline; for patients who presented with QTc <500 ms, QT c prolongation was defined solely as increase in QTc =60 ms from baseline. End points were assessed before (n=1200) and after (n=1200) implementation of the CDSS. CDSS implementation was independently associated with a reduced risk of QTc prolongation (adjusted odds ratio, 0.65; 95% confidence interval, 0.56-0.89; P>0.0001). Furthermore, CDSS implementation reduced the prescribing of noncardiac medications known to cause torsades de pointes, including fluoroquinolones and intravenous haloperidol (adjusted odds ratio, 0.79; 95% confidence interval, 0.63-0.91; P=0.03). Conclusions-A computer CDSS incorporating a validated risk score for QT c prolongation influences the prescribing of QT-prolonging drugs and reduces the risk of QTc interval prolongation in hospitalized patients with torsades de pointes risk factors. (Circ Cardiovasc Qual Outcomes. 2014;7:381-390.)

AB - Background-We evaluated the effectiveness of a computer clinical decision support system (CDSS) for reducing the risk of QT interval prolongation in hospitalized patients. Methods and Results-We evaluated 2400 patients admitted to cardiac care units at an urban academic medical center. A CDSS incorporating a validated risk score for QTc prolongation was developed and implemented using information extracted from patients' electronic medical records. When a drug associated with torsades de pointes was prescribed to a patient at moderate or high risk for QTc interval prolongation, a computer alert appeared on the screen to the pharmacist entering the order, who could then consult the prescriber on alternative therapies and implement more intensive monitoring. QTc interval prolongation was defined as QTc interval <500 ms or increase in QTc of =60 ms from baseline; for patients who presented with QTc <500 ms, QT c prolongation was defined solely as increase in QTc =60 ms from baseline. End points were assessed before (n=1200) and after (n=1200) implementation of the CDSS. CDSS implementation was independently associated with a reduced risk of QTc prolongation (adjusted odds ratio, 0.65; 95% confidence interval, 0.56-0.89; P>0.0001). Furthermore, CDSS implementation reduced the prescribing of noncardiac medications known to cause torsades de pointes, including fluoroquinolones and intravenous haloperidol (adjusted odds ratio, 0.79; 95% confidence interval, 0.63-0.91; P=0.03). Conclusions-A computer CDSS incorporating a validated risk score for QT c prolongation influences the prescribing of QT-prolonging drugs and reduces the risk of QTc interval prolongation in hospitalized patients with torsades de pointes risk factors. (Circ Cardiovasc Qual Outcomes. 2014;7:381-390.)

KW - Computer-assisted

KW - Electrocardiography

KW - Medical decision making

KW - Risk score

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