Project Details - Ongoing
- Grant Number:R18 HS026662
- AHRQ Funded Amount:$776,430
- Principal Investigator:
- Project Dates:4/1/2019 to 3/31/2021
- Care Setting:
- Medical Condition:
- Type of Care:
- Health Care Theme:
Torsades des Pointes (TdP) is a life-threatening, uncommon cardiac arrhythmia, characterized by a prolonged heart rate-corrected QT interval (QTc) noted on an electrocardiogram. Risk factors for TdP include heart failure, advanced age, female sex, electrolyte imbalances, and certain medications. Over 150 prescribed medications currently in use can prolong QTc intervals. For someone with a TdP risk factor, taking a QTc interval prolonging medication can have significant consequences, including death. Mitigating the risk of TdP can be a challenge for health care providers, as there is a lack of knowledge of TdP, its risk factors, and the significance of the QT interval. The use of a clinical decision support (CDS) tool could help providers identify those patients at risk for developing cardiac arrhythmias that could lead to TdP.
This research extends an existing CDS incorporating QTc risk score (QTc-RS) to identify patients at risk of increased QTc intervals and subsequent TdP. Providers will receive training on TdP, QTc, and the CDS so that healthcare providers better understand this arrhythmia, will be prepared to interpret QTc-RS, and be ready to provide appropriate patient care. Currently in use in intensive care and coronary care units in several US hospitals, the CDS will be further disseminated across multiple acuity levels within a large, seven-state regional hospital system in the western United States serving underserved and disadvantaged populations.
The specific aims of the research are as follows:
- Adapt, implement, and distribute a QTc-RS CDS in urban and rural inpatient care facilities across varying acuity levels.
- Develop and deliver an educational program on QTc interval prolongation, TdP, and the QTc-RS to inpatient healthcare providers.
- Evaluate the effectiveness of a QTc-RS CDS with respect to process changes within facilities, patient-focused clinical outcomes, and end-user satisfaction.
The research team hypothesizes that the use of the QTc-RS CDS tool will reduce instances of drug-induced prolonged QTc interval, shorten hospital stays, and result in fewer sudden cardiac deaths. By implementing and evaluating a multifaceted, sustainable training program addressing healthcare provider knowledge deficits in cardiac arrhythmias, this research has the potential to see improvements in patient safety and end-user satisfaction. The findings of this multi-year research may help guide future dissemination to additional hospital systems and further reduce the impact of TdP.