Application of a computerized medical decision-making process to the problem of digoxin intoxication

• HIT Description: Computerized decision support with alerts. More info...
  
• Purpose of Study: To assess the effect of "digoxin alert report" on patientsÕ management of digoxin.
  
• Years of study: Not Available
  
• Study Design: RCT
  
• Outcomes: Impact on patient safety, Impact on health care effectivness/quality, Other outcome
  

• Settings: All patients receiving digoxin at the LDS Hospital, Salt Lake City, Utah were included in the study
• Intervention: A group with a computerized medical decision-making system created a "digoxin alert report" that was placed on the individual patients' charts was compared to a nonalert group.
• Evaluation Method: Measures of physician's actions in relation to the digoxin alerts.
• Description: The ÒHELP Computer SystemÓ was used to monitor signs and predisposing factors of digoxin intoxication in patients receiving digoxin. This system automatically reviewed the patient's data base nightly for drug interactions, laboratory data and electrocardiographic findings with known association with digoxin intoxication. These decisions were formatted into a "digoxin alert report" and sent to line printers in the nursing division to be placed on the individual patients' charts.
• Healthcare Utilization: Seventy-two percent of patients received at least one alert. The most frequently occurring alerts included: hypoxemia, hypokalemia, concurrent use of a beta-adrenergic blocking agent, renal insufficiency and ventricular arrhythmia. Results demonstrated a 22% increase in physician actions for the alert group, and they were 2.7 times more likely to have a serum digoxin determination ordered on the day of an alert than were patients in the nonalert group.
• Quality of Care and Patient Safety Outcome: Patients in the alert group were 2.8 times more likely to have digoxin withheld on the day of a digoxin alert than were patients in the nonalert group.