A trial of automated safety alerts for inpatient digoxin use with computerized physician order entry

• HIT Description: synchronous and asynchronous clinical decision support (CDS) system for digoxin More info...
  
• Purpose of Study: compare the time for physician action regarding digoxin use before and after implementation of synchronous alerts (occurring at the time of ordering) and asynchronous alerts (presented as print-outs for responsible providers)
  
• Years of study: 2001-2002
  
• Study Design: historical control trial
  
• Outcomes: impact on healthcare effectiveness and quality, impact on efficiency, utilization and costs
  

• Settings: University of Illinois Hospital and Medical Center
• Intervention: Providers were subjected to pop-up electronic alerts (synchronous alerts) when ordering digoxin if there were potentially dangerous abnormal laboratory results. Printed alerts (asynchronous alerts) were also produced at nursing stations or inpatient pharmacies in response to abnormal laboratory results that could increase the risk of digoxin toxicity and were also sent to the provider's electronic clinical inbox. Response times were compared with an historical control cohort that would have been subject to the alerts.
• Evaluation Method: chart review
• Description: CDS is based on decision support rules that depend on patient-specific information maintained in the electronic medical record. It is evoked when digoxin is ordered using CPOE and there are specific elecrolyte laboratory values outside of a range and no concurrent orders for replacement; or, when a potentially interacting medication is ordered
• Quality of Care and Patient Safety Outcome: There was a significant improvement in time to ordering appropriate lab tests after implementation of the CDS. Compliance with supplementation of untreated hypokalemia and hypomagnesemia was improved with the asynchronous alerts but not with the synchronous alerts.