Three studies from Michigan Medicine suggest that well-designed alerts for critically ill cardiac patients can change what happens at the bedside.

In the first study, researchers evaluated a tool to help clinicians choose the appropriate dose of an intravenous loop diuretic for patients with acute decompensated heart failure. This medication removes excess fluid, allowing the heart to pump more effectively and relieve shortness of breath. Alerts of fluid overload or kidney dysfunction were triggered in 223 patient encounters. Using the alert did not delay treatment, showing that “these tools are easily used in a clinical setting and affect treatment decisions,” according to an author on the studies.

Another study looked at sedation practices in over 1,600 patients on a ventilator. The research team introduced an EHR-based intervention encouraging physicians and nurses to use lighter sedation. The average amount of time patients spent deeply sedated dropped after implementation.

The third study examined how targeted alerts help clinicians identify normotensive cardiogenic shock. This condition can be difficult to recognize because it’s often linked to low blood pressure, but delays in diagnosis can be life-threatening. Clinicians engaged with an alert identifying patients who displayed physiological signs of the condition 14% of the time, and those encounters were linked with higher rates of cardiac ICU consultation within 12 hours.

The three studies illustrate how targeted EHR alerts can assist clinicians across the continuum of critical cardiac care. The studies offer proof of concept, but more work is required to ensure electronic alerts are beneficial without disrupting clinical workflow.