Benefit of an electronic medical record-based alarm in the optimization of stress ulcer prophylaxis / Beneficio de una alarma electrónica de la historia clínica en la optimización de la profilaxis de la úlcera por estrés

BACKGROUND: The use of stress ulcer prophylaxis (SUP) has risen in recent years, even in patients without a clear indication for therapy. AIM: To evaluate the efficacy of an electronic medical record (EMR)-based alarm to improve appropriate SUP use in hospitalized patients. METHODS: We conducted an uncontrolled before-after study comparing SUP prescription in intensive care unit (ICU) patients and non-ICU patients, before and after the implementation of an EMR-based alarm that provided the correct indications for SUP. RESULTS: 1627 patients in the pre-intervention and 1513 patients in the post-intervention cohorts were included. The EMR-based alarm improved appropriate (49.6% vs. 66.6%, p < 0.001) and reduced inappropriate SUP use (50.4% vs. 33.3%, p < 0.001) in ICU patients only. These differences were related to the optimization of SUP in low risk patients. There was no difference in overt gastrointestinal bleeding between the two cohorts. Unjustified costs related to SUP were reduced by a third after EMR-based alarm use. CONCLUSIONS: The use of an EMR-based alarm improved appropriate and reduced inappropriate use of SUP in ICU patients. This benefit was limited to optimization in low risk patients and associated with a decrease in SUP costs

ANTECEDENTES: El uso de la profilaxis de úlceras por estrés (PUE) ha aumentado en los últimos años, incluso en pacientes sin indicación. OBJETIVO: Evaluar la eficacia de una alarma electrónica en la historia clínica (AEHC) para mejorar el uso apropiado de la PUE en pacientes hospitalizados. MÉTODOS: Estudio no controlado antes-después para comparar la prescripción de la PUE en pacientes de la unidad de cuidados intensivos (UCI) y sala general, antes y después de la implementación de una AEHC que proporcionaba las indicaciones correctas de la PUE. RESULTADOS: Se incluyeron 1.627 pacientes en la cohorte previa a la intervención y 1.513 pacientes en la cohorte posterior a la intervención. La AEHC mejoró el uso apropiado (49,6 vs. 66,6%; p < 0,001) y redujo el uso inapropiado de la PUE (50,4 vs. 33,3%; p < 0,001) solo en pacientes de la UCI. Estas diferencias se relacionaron a la optimización del uso de la PUE en pacientes de bajo riesgo. No hubo diferencias en la frecuencia de hemorragia digestiva manifiesta entre ambas cohortes. El uso de la AEHC redujo un tercio del costo injustificado relacionado con la PUE. CONCLUSIONES: El uso de una AEHC mejoró el uso apropiado de la PUE y redujo el uso inapropiado de la PUE en pacientes de la UCI. Este beneficio fue limitado a la optimización del uso de la PUE en pacientes de bajo riesgo y se asoció a una disminución del costo de la PUE

Benefit of an electronic medical record-based alarm in the optimization of stress ulcer prophylaxis.

BACKGROUND: The use of stress ulcer prophylaxis (SUP) has risen in recent years, even in patients without a clear indication for therapy. AIM: To evaluate the efficacy of an electronic medical record (EMR)-based alarm to improve appropriate SUP use in hospitalized patients. METHODS: We conducted an uncontrolled before-after study comparing SUP prescription in intensive care unit (ICU) patients and non-ICU patients, before and after the implementation of an EMR-based alarm that provided the correct indications for SUP. RESULTS: 1627 patients in the pre-intervention and 1513 patients in the post-intervention cohorts were included. The EMR-based alarm improved appropriate (49.6% vs. 66.6%, p<0.001) and reduced inappropriate SUP use (50.4% vs. 33.3%, p<0.001) in ICU patients only. These differences were related to the optimization of SUP in low risk patients. There was no difference in overt gastrointestinal bleeding between the two cohorts. Unjustified costs related to SUP were reduced by a third after EMR-based alarm use. CONCLUSIONS: The use of an EMR-based alarm improved appropriate and reduced inappropriate use of SUP in ICU patients. This benefit was limited to optimization in low risk patients and associated with a decrease in SUP costs.