Abstract
Commonly used drugs in hospital setting can cause QT prolongation and trigger life-threatening arrhythmias. We evaluate changes in prescribing behavior after the implementation of a clinical decision support system to prevent the use of QT prolonging medications in the hospital setting. We conducted a quasi-experimental study, before and after the implementation of a clinical decision support system integrated in the electronic medical record (QT-alert system). This system detects patients at risk of significant QT prolongation (QTc>500ms) and alerts providers ordering QT prolonging drugs. We reviewed the electronic health record to assess the provider’s responses which were classified as “action taken” (QT drug avoided, QT drug changed, other QT drug(s) avoided, ECG monitoring, electrolytes monitoring, QT issue acknowledged, other actions) or “no action taken”. Approximately, 15.5% (95/612) of the alerts were followed by a provider’s action in the pre-intervention phase compared with 21% (228/1085) in the post-intervention phase (p=0.006). The most common type of actions taken during pre-intervention phase compared to post-intervention phase were ECG monitoring (8% vs. 13%, p=0.002) and QT issue acknowledgment (2.1% vs. 4.1%, p=0.03). Notably, there was no significant difference for other actions including QT drug avoided (p=0.8), QT drug changed (p=0.06) and other QT drug(s) avoided (p=0.3). Our study demonstrated that the QT alert system prompted a higher proportion of providers to take action on patients at risk of complications. However, the overall impact was modest underscoring the need for educating providers and optimizing clinical decision support to further reduce drug-induced QT prolongation.
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This study was supported partially by a generous gift from the Frederick W. Smith family and by the Mayo Clinic Windland Smith Rice Comprehensive Sudden Cardiac Death Program. Its contents are solely the responsibility of the authors.
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Dr. Ackerman is a consultant for Boston Scientific, Gilead Sciences, Invitae, Myokardia, Medtronic, and St. Jude Medical. Dr. Ackerman and Mayo Clinic receive sales based royalties from Transgenomic for their FAMILION-LQTS and FAMILION-CPVT genetic tests. The other authors have no conflicts of interest to disclose. None of the disclosures pertain to this paper and none of the companies provided financial support for this paper.
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This article is part of the Topical Collection on Systems-Level Quality Improvement
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Sharma, S., Martijn Bos, J., Tarrell, R.F. et al. Providers’ Response to Clinical Decision Support for QT Prolonging Drugs. J Med Syst 41, 161 (2017). https://doi.org/10.1007/s10916-017-0803-7
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DOI: https://doi.org/10.1007/s10916-017-0803-7