Using clinical decision support tools to increase defibrillator deactivations in dying patients

Abstract

Inadvertent automatic implantable cardioverter defibrillator (AICD) shocks at the end of life are distressing and should be avoided.1 2 Up to 65% of AICDs are active and up to 33% of patients with AICDs receive shocks within 24 hours of dying.3 Though guidelines encourage device discussions, one study demonstrated only 27% of clinicians brought up AICD deactivation.2 4 Since the Health Information Technology for Economic and Clinical Health Act was passed in 2009, clinicians and IT professionals introduced evidence-based clinical decision support (CDS) models into patient care, including order sets and alerts.5 Our group was the first to demonstrate that educational sessions paired with a novel CDS tool in the electronic medical record (EMR) significantly improved the rates of AICD deactivation discussions and of shock function deactivation.6 However, a criticism was that the labour-intensive teaching sessions drove most of the improvement and EMR modifications are ineffective. As a result, we sought to investigate whether the CDS tool alone invoked more AICD deactivation discussions and AICD deactivations.