SHM Converge Scientific Abstract ePoster Gallery-Leaving the Tool in the Toolbox: Evaluating the Efficacy of an Ehr Clinical Decision Support on Door-to-Diuretic Time and Diuretic Dose Adequacy in Patients With Heart Failure

Leaving the Tool in the Toolbox: Evaluating the Efficacy of an Ehr Clinical Decision Support on Door-to-Diuretic Time and Diuretic Dose Adequacy in Patients With Heart Failure

Back to course

Pdf Summary

This quality improvement study evaluated whether an electronic health record (EHR) clinical decision support system (CDSS) could improve rapid treatment of acute heart failure in the emergency department by reducing door-to-diuretic (D2D) time and improving intravenous diuretic dosing.<br /><br />At Thomas Jefferson University Hospital, baseline performance in August 2024 showed a mean D2D time of 4.03 hours and an average dosing ratio of 111%. In November 2024, the team implemented interventions including caregiver education, financial incentives, and an EHR heart failure order set with CDSS. Post-intervention data from May 2025 were compared with baseline using manual chart review and descriptive statistics.<br /><br />Results showed no significant improvement. Mean D2D time increased slightly to 4.56 hours, and mean dosing ratio rose to 132%, but neither change was statistically significant. Both cohorts remained far above the 60-minute D2D target associated with better outcomes. Electronic tool adoption was very low: only 10.4% of post-intervention cases used the heart failure admission order set. However, dosing variability improved somewhat, with the standard deviation decreasing from 104% to 71%, suggesting greater consistency.<br /><br />The study concluded that EHR-based CDSS tools alone were insufficient to improve acute heart failure management in a busy urban emergency department. The findings suggest that isolated electronic interventions, without stronger workflow integration or broader system redesign, are unlikely to produce meaningful change. Future directions include refining EHR prompts, testing non-EHR strategies such as nurse-led protocols or multidisciplinary teams, improving automated real-time feedback, and validating findings in larger and more diverse hospital settings.

Asset Subtitle

Alan Kubey

Meta Tag

Author List Alan Kubey, Hajae Ko

Category Research

Concept Acute Heart Failure

Concept IV Diuretics

Concept Door-to-Diuretic Time

Concept Pre-Post Study Design

Concept Quality Improvement Study

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University and Mayo Clinic

Presenting Author Alan Kubey

Track Quality Improvement

Keywords

electronic health record

clinical decision support system

acute heart failure

emergency department

door-to-diuretic time

intravenous diuretic dosing

quality improvement study

order set adoption

workflow integration

caregiver education

Acute Heart Failure

IV Diuretics

Door-to-Diuretic Time

Pre-Post Study Design

Quality Improvement Study