SHM Converge Scientific Abstract ePoster Gallery-A Non-Intrusive Advisory to Reduce Inappropriate Stress Ulcer Prophylaxis for Non-Critically Ill Patients Across 11 Acute Care Hospitals.

A Non-Intrusive Advisory to Reduce Inappropriate Stress Ulcer Prophylaxis for Non-Critically Ill Patients Across 11 Acute Care Hospitals.

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A non-intrusive electronic advisory was implemented across 11 acute care hospitals in a large municipal health system to reduce inappropriate stress ulcer prophylaxis (SUP) with proton pump inhibitors, especially for patients transferred out of the ICU and kept on routine once-daily IV pantoprazole without a clear indication. The intervention was designed to prompt clinicians without interrupting workflow and appeared as a sidebar notification in Epic.<br /><br />The background for the project was that routine SUP outside the ICU is generally discouraged, yet patients are often continued on PPIs inappropriately during hospitalization and even at discharge. This exposes patients to unnecessary risks, including Clostridium difficile infection, and adds avoidable cost.<br /><br />The advisory was displayed in 2,349 encounters. Providers acted on it in 1,043 encounters, a response rate of 45.7%. Of those actions, 38.6% led to discontinuation of the PPI order, 54.2% resulted in continuation, and 7.1% involved discontinuation followed by re-ordering.<br /><br />Overall, weekly PPI ordering rates normalized per 1,000 inpatient days decreased from 27.05 before the intervention to 25.21 after the intervention, with statistical significance reported as p<0.05. The authors concluded that the non-intrusive advisory successfully prompted discontinuation of inappropriate or unnecessary SUP orders and may serve as a useful model for reducing low-value care in other clinical situations.

Asset Subtitle

Surafel Tsega

Meta Tag

Author List Joseph Talledo, Milana Zaurova, Mohit Hans, Mona Krouss, Peter Alarcon Manchego, Surafel Tsega

Category Research

Concept Gastrointestinal Stress Ulcer Prophylaxis

Concept Proton Pump Inhibitor

Concept Clinical Decision Support

Concept Practice Advisory

Concept Noncritically Ill Hospitalized Patient

Distinguished Non-Finalist

Presenter Organization New York City Health + Hospitals

Presenting Author Surafel Tsega

Track Value in Hospital Medicine

Keywords

stress ulcer prophylaxis

proton pump inhibitors

pantoprazole

clinical decision support

ICU transfer

hospitalized patients

inappropriate prescribing

Epic sidebar notification

PPI discontinuation

low-value care

Gastrointestinal Stress Ulcer Prophylaxis

Proton Pump Inhibitor

Clinical Decision Support

Practice Advisory

Noncritically Ill Hospitalized Patient