{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T04:43:33Z","timestamp":1768970613122,"version":"3.49.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"e1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We developed and implemented a \u2018CPOE-QT Alert\u2019 system, that is, clinical decision support integrated in the computerized physician order entry system (CPOE), in 2011. The system identifies any attempts to order medications with risk of torsade de pointes (TdP) for patients with a history of significant QT prolongation (QTc \u2265500 ms) and alerts the provider entering the order. We assessed its impact by comparing orders and subsequent medication administration before and after activation of the system. We found a significant decrease in the proportion of completed order per ordering attempt after system activation (94% (1293\/1379) vs 77% (1888\/2453), difference 16.8%; p&amp;lt;0.001). This resulted in a 13.9% reduction in the administration of those medications to patients. A significant decrease was observed across all provider types, educational levels, and specialties. The CPOE-QT Alert system successfully reduced exposure to QT-prolonging medications in high risk patients.<\/jats:p>","DOI":"10.1136\/amiajnl-2014-002896","type":"journal-article","created":{"date-parts":[[2014,10,17]],"date-time":"2014-10-17T11:24:45Z","timestamp":1413545085000},"page":"e21-e27","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Impact of clinical decision support preventing the use of QT-prolonging medications for patients at risk for torsade de pointes"],"prefix":"10.1093","volume":"22","author":[{"given":"Atsushi","family":"Sorita","sequence":"first","affiliation":[{"name":"Division of Preventive Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J Martijn","family":"Bos","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce W","family":"Morlan","sequence":"additional","affiliation":[{"name":"Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert F","family":"Tarrell","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J","family":"Ackerman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA"},{"name":"Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"},{"name":"Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro J","family":"Caraballo","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2014,10,16]]},"reference":[{"key":"2020110613000909400_R1","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1001\/jama.296.10.1249","article-title":"Risk of aborted cardiac arrest or sudden cardiac death during adolescence in the long-QT syndrome","volume":"296","author":"Hobbs","year":"2006","journal-title":"JAMA"},{"key":"2020110613000909400_R2","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1001\/archinte.164.9.943","article-title":"Prolonged QTc interval and risks of total and cardiovascular mortality and sudden death in the general population: a review and qualitative overview of the prospective cohort studies","volume":"164","author":"Montanez","year":"2004","journal-title":"Arch Intern Med"},{"key":"2020110613000909400_R3","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.jacc.2005.08.067","article-title":"Prolonged QTc interval and risk of sudden cardiac death in a population of older adults","volume":"47","author":"Straus","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"2020110613000909400_R4","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/EDE.0b013e318225768b","article-title":"Electrocardiographic QT interval and mortality: a meta-analysis","volume":"22","author":"Zhang","year":"2011","journal-title":"Epidemiology"},{"key":"2020110613000909400_R5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1056\/NEJMoa0806994","article-title":"Atypical antipsychotic drugs and the risk of sudden cardiac death","volume":"360","author":"Ray","year":"2009","journal-title":"N Engl J Med"},{"key":"2020110613000909400_R6","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1056\/NEJMoa1003833","article-title":"Azithromycin and the risk of cardiovascular death","volume":"366","author":"Ray","year":"2012","journal-title":"N Engl J Med"},{"key":"2020110613000909400_R7","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.jacc.2010.01.001","article-title":"Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation","volume":"55","author":"Drew","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2020110613000909400_R8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1002\/phar.1242","article-title":"Agreement between ICU clinicians and electrophysiology cardiologists on the decision to initiate a QTc-interval prolonging medication in critically ill patients with potential risk factors for torsade de pointes: a comparative, case-based evaluation","volume":"33","author":"Fongemie","year":"2013","journal-title":"Pharmacotherapy"},{"key":"2020110613000909400_R9"},{"key":"2020110613000909400_R10","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.mayocp.2013.01.013","article-title":"Institution-wide QT alert system identifies patients with a high risk of mortality","volume":"88","author":"Haugaa","year":"2013","journal-title":"Mayo Clin Proc"},{"key":"2020110613000909400_R11"},{"key":"2020110613000909400_R12","author":"R Development Core Team","year":"2011"},{"key":"2020110613000909400_R13","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1136\/bmj.38398.500764.8F","article-title":"Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success","volume":"330","author":"Kawamoto","year":"2005","journal-title":"BMJ"},{"key":"2020110613000909400_R14","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1001\/archinte.163.21.2625","article-title":"Physicians\u2019 decisions to override computerized drug alerts in primary care","volume":"163","author":"Weingart","year":"2003","journal-title":"Arch Intern Med"},{"issue":"1","key":"2020110613000909400_R15","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1136\/amiajnl-2011-000743","article-title":"Evaluating alert fatigue over time to EHR-based clinical trial alerts: findings from a randomized controlled study","volume":"19","author":"Embi","year":"2012","journal-title":"J Am Med Inform Assoc"},{"key":"2020110613000909400_R16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.7326\/0003-4819-157-1-201207030-00450","article-title":"Effect of clinical decision-support systems: a systematic review","volume":"157","author":"Bright","year":"2012","journal-title":"Ann Intern Med"},{"key":"2020110613000909400_R17","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s11606-008-0504-5","article-title":"The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review","volume":"23","author":"Wolfstadt","year":"2008","journal-title":"J Gen Intern Med"},{"key":"2020110613000909400_R18","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1001\/archinte.163.12.1409","article-title":"Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review","volume":"163","author":"Kaushal","year":"2003","journal-title":"Arch Intern Med"},{"key":"2020110613000909400_R19","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1056\/NEJMp1006114","article-title":"The \u201cmeaningful use\u201d regulation for electronic health records","volume":"363","author":"Blumenthal","year":"2010","journal-title":"N Engl J Med"},{"key":"2020110613000909400_R20"},{"key":"2020110613000909400_R21","first-page":"285","article-title":"Preventing torsades de pointes by careful cardiac monitoring in hospital settings","volume":"18","author":"Sommargren","year":"2007","journal-title":"AACN Adv Crit Care"},{"issue":"54(Suppl)","key":"2020110613000909400_R22","first-page":"S15","article-title":"Minimizing the risk for QT interval prolongation","author":"Slama","year":"2005","journal-title":"J Fam Pract"},{"key":"2020110613000909400_R23","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1016\/j.jacc.2006.07.010","article-title":"ACC\/AHA\/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology\/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)","volume":"48","author":"Zipes","year":"2006","journal-title":"J Am Coll Cardiol"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/22\/e1\/e21\/34146186\/amiajnl-2014-002896.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/22\/e1\/e21\/34146186\/amiajnl-2014-002896.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T02:44:35Z","timestamp":1650422675000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/22\/e1\/e21\/702162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10,16]]},"references-count":23,"journal-issue":{"issue":"e1","published-online":{"date-parts":[[2014,10,16]]},"published-print":{"date-parts":[[2015,4,1]]}},"URL":"https:\/\/doi.org\/10.1136\/amiajnl-2014-002896","relation":{},"ISSN":["1527-974X","1067-5027"],"issn-type":[{"value":"1527-974X","type":"electronic"},{"value":"1067-5027","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,4]]},"published":{"date-parts":[[2014,10,16]]}}}