Secondary Logo

Institutional members access full text with Ovid®

Using Clinical Decision Support to Improve Referral Rates in Severe Symptomatic Aortic Stenosis

A Quality Improvement Initiative

Kirby, Amanda M., DNP, ACNP; Kruger, Bradley, MBA; Jain, Renuka, MD; O'Hair, Daniel P., MD; Granger, Bradi B., PhD

CIN: Computers, Informatics, Nursing: November 2018 - Volume 36 - Issue 11 - p 525–529
doi: 10.1097/CIN.0000000000000471

Clinical decision support systems are used to ensure compliance with guidelines and can assist providers in improving quality of care. This quality improvement initiative was designed to evaluate the use of a clinical decision support system to improve specialist referral rate for patients with severe aortic stenosis. A clinical decision support system for cardiology and primary care providers was implemented to improve diagnosis of severe aortic stenosis. The ordering provider received an electronic medical record in-basket alert providing feedback and recommendations for referral to specialist for evaluation. The echocardiogram data were evaluated for change in specialist referral rate. Before clinical decision support system implementation, the referral rate was 72% for a 3-month period. All providers ordering echocardiograms received clinical decision support system notification if patient results met criteria based on valve severity (aortic valve area < 1.0 cm2, mean gradient ≥ 40 mm Hg, peak velocity ≥ 4.0 m/s). After implementation, clinical decision support system referral rate was 97.5%, a 24.6% increase in referral rates (P < .001). Low referral rates for patients with severe aortic stenosis are a recognized challenge. Utilizing the clinical decision support system to improve awareness of quality guidelines and recommendations was associated with increased adherence to referral guidelines by providers. This innovation is pertinent to practice and enhances the functionality of the electronic medical record by providing real-time feedback to providers to improve practice. Referral rates for patients with severe aortic stenosis can be improved with use of provider clinical decision support system.

Author Affiliations: Cardiovascular and Thoracic Surgery, Aurora Medical Group (Drs Kirby and O'Hair); and Administration, Aurora Health Care (Mr Kruger), Milwaukee, WI; School of Nursing, Duke University (Dr Granger), Durham, NC; and Cardiology, Aurora Medical Group (Dr Jain), Milwaukee, WI.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Corresponding author: Amanda M. Kirby, DNP, ACNP, 2400 S Brookside Pkwy, New Berlin, WI 53151 (

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.