What does this research mean for the field?

Clinician engagement with an interruptive EHR alert workflow for normotensive cardiogenic shock is associated with increased rates of cardiac intensive care unit consultation within 12 hours. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the impact of an interruptive electronic health record alert on the identification of normotensive cardiogenic shock physiology and timely escalation to specialized cardiac intensive care.

September 19, 2026JACC Case ReportsOpen Access

Engaging with normotensive cardiogenic shock EHR alerts is linked to ~105% more 12-hour CICU consults.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Normotensive cardiogenic shock (n=50). Intervention: Clinician engagement with an interruptive EHR alert workflow vs. No clinician engagement with the alert workflow. Primary outcome: CICU consultation within 12 hours.

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Why the study?

Normotensive cardiogenic shock is an under-recognized clinical phenotype associated with delayed recognition and escalation to specialized care.

Does an interruptive EHR alert improve timely escalation to CICU consultation for patients with potential normotensive cardiogenic shock?

Comparison

Clinician engagement with EHR alert workflow vs no engagement

Design

Observational evaluation of interruptive EHR alert implementation

Follow-up

12 hours

Key result

Clinician engagement with an interruptive EHR alert for normotensive cardiogenic shock was associated with higher rates of CICU consultation within 12 hours (42.9% vs 20.9%).

Authors

SASarah Adie MKMatthew Kennedy ASAdam Stein

Discussion

Member takes

Overview

Low alert engagement limits immediate use; hypothesis-generating for EHR alerts in normotensive shock and requires prospective validation.

Key Points

To evaluate the impact of an interruptive electronic health record alert on the identification of normotensive cardiogenic shock physiology and timely escalation to specialized cardiac intensive care.
Implemented an interruptive EHR alert with an embedded escalation workflow (allowing direct ordering of CICU consultation or repeat lactate measurement) at a tertiary academic medical center between December 2025 and March 2026.
Evaluated clinical responses and workflow escalation across 50 triggered alert events.
Clinicians engaged with the alert workflow in 14% of triggered instances.
Engagement with the alert workflow was associated with higher rates of CICU consultation within 12 hours compared to non-engagement (42.9% vs 20.9%).
Alert implementation improved the overall reliability of escalation decisions rather than modifying consultation timing once escalation was initiated.

Study Design

Type

Observational (n=50)

Multicenter

Structured PICO

Does an interruptive EHR alert improve timely escalation to CICU consultation for patients with potential normotensive cardiogenic shock?

Population

50 EHR alert triggers for potential normotensive cardiogenic shock physiology evaluated at a single tertiary academic medical center.

Exposure

Interruptive electronic health record (EHR) alert with an embedded escalation workflow allowing clinicians to directly order cardiac intensive care unit (CICU) consultation and/or repeat lactate measurement

Comparator

Alerts without clinician engagement with the workflow

Outcome

CICU consultation within 12 hours

Main Result

Absolute Event Rate: 42.9% vs 20.9%

An EHR-based behavioral nudge embedded within clinician workflows can improve the reliability of escalation to specialized care for patients with under-recognized normotensive cardiogenic shock.

Cite This Study

Adie et al. (2026) conducted an observational in Normotensive cardiogenic shock (n=50). Clinician engagement with an interruptive EHR alert workflow vs. No clinician engagement with the alert workflow was evaluated on CICU consultation within 12 hours. Clinician engagement with an interruptive EHR alert for normotensive cardiogenic shock was associated with higher rates of CICU consultation within 12 hours (42.9% vs 20.9%).

synapsesocial.com/papers/6aae47640c69660b71ecc659 https://doi.org/10.1016/j.jaccas.2026.109450

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September 19, 2026JACC Case ReportsOpen Access

Engaging with normotensive cardiogenic shock EHR alerts is linked to ~105% more 12-hour CICU consults.

View Full Paper

Ask AI

Bookmark

Why the study?

Normotensive cardiogenic shock is an under-recognized clinical phenotype associated with delayed recognition and escalation to specialized care.

Does an interruptive EHR alert improve timely escalation to CICU consultation for patients with potential normotensive cardiogenic shock?

Comparison

Clinician engagement with EHR alert workflow vs no engagement

Design

Observational evaluation of interruptive EHR alert implementation

Follow-up

12 hours

Key result

Clinician engagement with an interruptive EHR alert for normotensive cardiogenic shock was associated with higher rates of CICU consultation within 12 hours (42.9% vs 20.9%).

Authors

SASarah Adie MKMatthew Kennedy ASAdam Stein

Discussion

Member takes

Overview

Low alert engagement limits immediate use; hypothesis-generating for EHR alerts in normotensive shock and requires prospective validation.

Key Points

To evaluate the impact of an interruptive electronic health record alert on the identification of normotensive cardiogenic shock physiology and timely escalation to specialized cardiac intensive care.
Implemented an interruptive EHR alert with an embedded escalation workflow (allowing direct ordering of CICU consultation or repeat lactate measurement) at a tertiary academic medical center between December 2025 and March 2026.
Evaluated clinical responses and workflow escalation across 50 triggered alert events.
Clinicians engaged with the alert workflow in 14% of triggered instances.
Engagement with the alert workflow was associated with higher rates of CICU consultation within 12 hours compared to non-engagement (42.9% vs 20.9%).
Alert implementation improved the overall reliability of escalation decisions rather than modifying consultation timing once escalation was initiated.

Study Design

Type

Observational (n=50)

Multicenter

Structured PICO

Does an interruptive EHR alert improve timely escalation to CICU consultation for patients with potential normotensive cardiogenic shock?

Population

50 EHR alert triggers for potential normotensive cardiogenic shock physiology evaluated at a single tertiary academic medical center.

Exposure

Comparator

Alerts without clinician engagement with the workflow

Outcome

CICU consultation within 12 hours

Main Result

Absolute Event Rate: 42.9% vs 20.9%

An EHR-based behavioral nudge embedded within clinician workflows can improve the reliability of escalation to specialized care for patients with under-recognized normotensive cardiogenic shock.

Cite This Study

synapsesocial.com/papers/6aae47640c69660b71ecc659 https://doi.org/10.1016/j.jaccas.2026.109450

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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