Electronic Risk Alerts to Improve Primary Care Management of Chest Pain: A Randomized, Controlled Trial

Sequist, Thomas D.; Morong, Shane M.; Marston, Amy; Keohane, Carol A.; Cook, E. Francis; Orav, E. John; Lee, Thomas H.

doi:10.1007/s11606-011-1911-6

Cited by 10 publications

(13 citation statements)

References 40 publications

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“…Embi and Leonard 16 discussed low levels of documentation after intervention as having multifactorial causes, which could be further understood by using qualitative study of end users' perceptions of BpAs. A lack of clinician buy-in to a BpA request for screening or documentation was illustrated by sequist et al, 14 whose electronic alerts (based on Framingham Risk score) did not improve adherence to documentation according to guidelines for chest pain management. Investigators surveyed clinicians at the study's end, finding that only 40% of their clinicians perceived the Framingham Risk score to be "often" valid.…”

Section: Large Versus Small Hospitalsmentioning

confidence: 99%

Computer-Assisted Interventions To Improve QTc Documentation in Patients Receiving QT-Prolonging Drugs

Sandau¹,

Sendelbach²,

Fletcher³

et al. 2015

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. discuss advantages of automated decision support tools. 2. describe the steps taken to improve documentation of QT intervals. 3. discuss risk factors for torsade de pointes.To read this article and take the CNE test online, visit www.ajcconline.org and click "CNE Articles in This Issue." No CNE test fee for AACN members.By Kristin E. sandau, RN, phd, CNE, sue sendelbach, RN, phd, CCNs, Linda Fletcher, MHI, Joel Frederickson, phd, Barbara J. drew, RN, phd, and Marjorie Funk, RN, phd Background Many medications commonly used in hospitals can cause prolonged corrected QT interval (QTc), putting patients at risk for torsade de pointes (TdP), a potentially fatal arrhythmia. However, documentation of QTc for hospitalized patients receiving QT-prolonging medications is often not consistent with American Heart Association standards. Objective To examine effects of education and computerized documentation enhancements on QTc documentation. Methods A quasi-experimental multisite study among 4011 cardiac-monitored patients receiving QTc-prolonging medications within a 10-hospital health care system was conducted to compare QTc documentation before (n=1517), 3 months after (n = 1301), and 4 to 6 months after (n = 1193) an intervention. The intervention included (1) online education for 3232 nurses, (2) electronic notifications to alert nurses when a patient received at least 2 doses of a QT-prolonging medication, and (3) computerized calculation of QTc in electronic health records after nurses had documented heart rate and QT interval. Results QTc documentation for inpatients receiving QTcprolonging drugs increased significantly from baseline (17.3%) to 3 months after the intervention (58.2%; P < .001) within the 10 hospitals and had increased further 4 to 6 months after the intervention (62.1%, P = .75). Patients at larger hospitals were significantly more likely to have their QTc documented (46.4%) than were patients at smaller hospitals (26.2%; P < .001). Conclusion A 3-step system-wide intervention was associated with an increase in QTc documentation for patients at risk for drug-induced TdP, and improvements persisted over time. Further study is needed to assess whether increased QTc documentation decreases occurrence of drug-induced TdP. (American Journal of Critical Care. 2015;24:e6-e15) Background Prolongation of QT IntervalOn the electrocardiogram (ECg), the QT interval represents both depolarization and repolarization of the ventricles.3 For practical clinical purposes, however, the QT interval is used as an indirect measure of ventricular repolarization because the start of the QRs complex is easy to identify; thus, measurement of the QT interval is initiated at the beginning of the QRs complex and terminated at the end of the T wave.4 patients with a prolonged QT interval are at risk for Tdp, a polymorphic ventricular tachycardia characterized by twisting points of the QRs complex a...

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Section: Large Versus Small Hospitalsmentioning

confidence: 99%

Computer-Assisted Interventions To Improve QTc Documentation in Patients Receiving QT-Prolonging Drugs

Sandau¹,

Sendelbach²,

Fletcher³

et al. 2015

American Journal of Critical Care

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“…These inconsistent findings of CDS effectiveness have been associated with barriers in workflow, usability, and integration. These adverse unintended consequences have made these interventions ineffective in provider behavior change and little impact on patient outcomes [5,29,[33][34][35].…”

Section: Introductionmentioning

confidence: 99%

User Centered Clinical Decision Support Tools

et al. 2014

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“…There are no other reviews on the use of CAHTS for the prevention of cardiovascular disease. Other studies (43,53,41,32,54,7) assessed the use of CAHTS on cardiovascular disease prevention and management, but these either did not compare oral to written history taking processes or were conducted in participants who did have pre-existing cardiovascular disease. In agreement with our findings they generally found that computer-assisted methods improved the prevention or management of patients with cardiovascular disease or with risk factors for cardiovascular disease.…”

Section: Cahts For Cvd Preventionmentioning

confidence: 99%

Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

Pappas

Všetečková

Poduval

et al. 2017

Acta Med. (Hradec Kralove, Czech Repub.)

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A B ST R AC T Background and objectives: CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing countries. It is also an extremely costly disease for healthcare systems unless managed effectively. In this review we aimed to: -Assess the effect of computer-assisted versus oral-and-written history taking on the quality of collected information for the prevention and management of CVD.-Assess the effect of computer-assisted versus oral-and-written history taking on the prevention and management of CVD. Methods: A systematic review of randomised controlled trials that included participants of 16 years or older at the beginning of the study, who were at risk of CVD (prevention) or were either previously diagnosed with CVD (management). We searched all major databases. We assessed risk of bias using the Cochrane Collaboration tool. Results: Two studies met the inclusion criteria. One comparing the two methods of history-taking for the prevention of cardiovascular disease n = 75. The study shows that generally the patients in the experimental group underwent more laboratory procedures, had more biomarker readings recorded and/or were given (or had reviewed), more dietary changes than the control group. The other study compares the two methods of history-taking for the management of cardiovascular disease (n = 479). The study showed that the computerized decision aid appears to increase the proportion of patients who responded to invitations to discuss CVD prevention with their doctor. The ComputerAssisted History Taking Systems (CAHTS) increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% and increased the proportion who had a specific plan to reduce their risk from 24% to 37%. Discussion: With only one study meeting the inclusion criteria, for prevention of CVD and one study for management of CVD we did not gather sufficient evidence to address all of the objectives of the review. We were unable to report on most of the secondary patient outcomes in our protocol. Conclusions: We tentatively conclude that CAHTS can provide individually-tailored information about CVD prevention. However, further primary studies are needed to confirm these findings. We cannot draw any conclusions in relation to any other clinical outcomes at this stage. There is a need to develop an evidence base to support the effective development and use of CAHTS in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted history taking may only rely on the clinicians' tacit knowledge, published monographs and viewpoint articles.

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Electronic Risk Alerts to Improve Primary Care Management of Chest Pain: A Randomized, Controlled Trial

Cited by 10 publications

References 40 publications

Computer-Assisted Interventions To Improve QTc Documentation in Patients Receiving QT-Prolonging Drugs

Computer-Assisted Interventions To Improve QTc Documentation in Patients Receiving QT-Prolonging Drugs

User Centered Clinical Decision Support Tools

Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

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