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

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 c 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 c 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 c interval prolongation was defined as QT c interval <500 ms or increase in QT c of =60 ms from baseline; for patients who presented with QT c <500 ms, QT c prolongation was defined solely as increase in QT c =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 c 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 QT c interval prolongation in hospitalized patients with torsades de pointes risk factors. (Circ Cardiovasc Qual Outcomes. 2014;7:381-390.) © 2014 American Heart Association, Inc.