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Ora Paltiel, MDCM, MSc; Lois Gordon, MPH; David Berg, BSc; Abraham Israeli, MD, MSc, MPH

Arch Intern Med. 2003;163:200-204.

Background  Electrolyte abnormalities, including hypokalemia, are frequently encountered among hospitalized patients. Their management, when carefully audited, reveals major shortcomings.

Objective  To evaluate the effect of a computerized alert on the management of severe hypokalemia in hospitalized patients.

Methods  All patients who experienced severe hypokalemia (serum potassium levels <3.0 mEq/L) during their hospitalization at Hadassah Medical Center (a 1000-bed teaching institution on 2 campuses in Jerusalem, Israel) were included in the study. The study intervention was a computerized alert consisting of a flashing screen or printed warning for patients with serum potassium levels below 3.0 mEq/L, visible whenever an individual patient's or entire ward's results were accessed on any hospital computer. Using a previously validated computerized audit technique, we analyzed the management of hypokalemia 6 months before and 6 months after implementation of the alert intervention.

Results  Comparing outcomes before and after the intervention, nonmeasurement of a subsequent serum potassium level after an initial low value decreased by 36.1% (P = .08). Failure to correct the serum potassium level to above 3.5 mEq/L during the hospitalization decreased by 28.6% (P = .02). Discharge from the hospital with a subnormal serum potassium level decreased by 17.2% (P = .06).

Conclusions  A computerized alert system improved the management of hypokalemia in a tertiary care hospital. This was achieved at minimal cost and with no evidence of harm. The computerized audit based on a laboratory information system is an efficient tool for evaluating this intervention.

From the Departments of Social Medicine (Dr Paltiel and Ms Gordon), Hematology (Dr Paltiel), and Information Systems (Mr Berg), Hadassah Medical Center, and School of Public Health (Drs Paltiel and Israeli and Ms Gordon), Hadassah-Hebrew University, Jerusalem, Israel.

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