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Improving Recognition of Normotensive Cardiogenic Shock Through an Electronic Health Record Nudge
Sarah K Adie1, Matthew Kennedy2, Adam Stein3
1Department of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Background:
Cardiogenic shock (CS) may occur despite preserved blood pressure, contributing to delayed recognition and escalation to specialized care.
Project Rationale:
We implemented an interruptive electronic health record (EHR) alert designed to identify normotensive CS physiology and facilitate timely escalation to cardiac intensive care unit (CICU) consultation.
Project Summary:
We evaluated implementation of an interruptive EHR alert designed to identify patients with potential normotensive CS physiology at a tertiary academic medical center between December 2025 and March 2026. The alert incorporated an embedded escalation workflow allowing clinicians to directly order CICU consultation and/or repeat lactate measurement. Fifty alert triggers were analyzed. Clinician engagement with the alert workflow occurred in 14% of triggered alerts and was associated with higher rates of CICU consultation within 12 hours (42.9% vs 20.9%). Findings primarily demonstrated improved reliability of escalation decisions rather than changes in consultation timing once escalation occurred.
Take-Home Messages:
Normotensive CS is an under-recognized clinical phenotype associated with delayed escalation. EHR-based behavioral nudges embedded within clinician workflow may improve escalation reliability for high-risk patients with evolving shock physiology.
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