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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Improving Recognition of Normotensive Cardiogenic Shock Through an Electronic Health Record Nudge

  • Sarah K. Adie1,2
  • Matthew Kennedy3
  • Adam Stein2
  • Raymond A. Pashun2
  • Christopher R. Zimmerman4
  • Eric P. Cantey2
  • Stephanie Steadman5
  • Scott W. Ketcham2
5 affiliations
  1. 1Department of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
  4. 4Michigan Medicine, Health Information and Technology Services, Ann Arbor, Michigan, USA
  5. 5Michigan Medicine, Quality Department, Ann Arbor, Michigan, USA
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Abstract

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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Cite

BibTeXRIS
BibTeX
@article{adie2026improving,
  title = {{Improving Recognition of Normotensive Cardiogenic Shock Through an Electronic Health Record Nudge}},
  author = {Sarah K. Adie and Matthew Kennedy and Adam Stein and Raymond A. Pashun and Christopher R. Zimmerman and Eric P. Cantey and Stephanie Steadman and Scott W. Ketcham},
  journal = {JACC Case Reports},
  year = {2026},
  month = sep,
  doi = {10.1016/j.jaccas.2026.109450},
  url = {https://doi.org/10.1016/j.jaccas.2026.109450},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Improving Recognition of Normotensive Cardiogenic Shock Through an Electronic Health Record Nudge
AU  - Sarah K. Adie
AU  - Matthew Kennedy
AU  - Adam Stein
AU  - Raymond A. Pashun
AU  - Christopher R. Zimmerman
AU  - Eric P. Cantey
AU  - Stephanie Steadman
AU  - Scott W. Ketcham
PY  - 2026
DA  - 2026/09/16
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109450
UR  - https://doi.org/10.1016/j.jaccas.2026.109450
AB  - 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.
SN  - 2666-0849
ER  -