351 - Risk to Referral: An EHR-based Sudden Cardiac Event Screening and Management Program

Poster Number: 351
Publication Number: 351.1595

Background: Sudden Cardiac Death (SCD) occurs in ~1/200,000 children and young adults each year. To prevent some of these deaths, a July 2021 American Academy of Pediatrics policy statement called for universal cardiac risk screening every 2-3 years starting at middle school age; the policy provided 4 screening questions for primary care providers (PCP). We developed a streamlined screening and management protocol which included clinical decision support to identify and manage pediatric patients at increased risk for sudden cardiac events.

Objective: Create a reliable process that ensures patients receive SCD risk screening and appropriate responses to any positive questionnaires.

Design/Methods: A simplified questionnaire based on the AAP’s 4 questions was developed by a team of PCPs, pediatric cardiologists, and informaticians (fig 1). We also created an EHR-based workflow for questionnaire distribution and response to positive screens (fig 2).

The screen was sent via the patient portal 7 days prior to well visits at ages 8, 11, 14, and 17 years. If not completed electronically, the screen could be completed during the visit. Positive screens would trigger a non-interruptive alert that would remain visible to all providers until acknowledged or action was taken. The alert itself contained ordering tools for further evaluation and referral.

Counts of positive screens and PCP interaction with the alert were evaluated during the pilot phase. Further statistics are being collected as additional patients continue to be screened.

Results: From 9/19/2023 to 10/20/2023, 739 patients qualified for cardiac screening; 624 cardiac screens were sent and 227 (36%) were completed via the patient portal. An additional 177 screens were documented in the office. Of the 404 total screenings, 50 (12%) were positive. After 1 month, we discovered that the alert had fired for only 19 of the 50 positive screens due to a coding error. Of the 19 patients with alerts, 7 were referred to cardiology and 4 had EKG obtained.
A few non-pilot sites completed the screening forms, mostly in the office. 54 non-pilot screens were completed, 6 (11%) were positive, and the BPA fired for 5. In total, the alert fired for 24 (42%) positive screens. Of these 24 alerts, 4 patients had EKGs ordered and 10 were referred to cardiology.
The alert logic has been re-configured and is functioning properly. The second month pilot and data collection has begun.

Conclusion(s): Implementation of a patient-portal and EHR-based sudden cardiac risk screening program can improve identification of high-risk patients and simplify PCP response to positive screening.