Endocrine Abstracts

JOINT1130

Background: Clinical decision support (CDS) is a health information technology tool designed to aid healthcare providers in making informed decisions during patient care. However, evidence on the effectiveness of CDS systems in improving the identification and management of adrenal insufficiency (AI) and reducing preventable adrenal crises in emergency departments (EDs) is limited.

Methods: We conducted a retrospective analysis of patients with AI who followed up at the endocrinology clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. All patients were identified using a medical alert system integrated into the electronic health record (EHR). The primary outcome was the time from ED arrival to glucocorticoid administration in AI patients visiting the EDs during the 12-month period before and after the system’s implementation. Secondary outcomes included the proportion of patients receiving appropriate glucocorticoid treatment and the frequency of preventable adrenal crises in the EDs before and after implementation.

Results: Among 112 patients with AI, 4 patients (4%) had primary AI, and 108 patients (96%) had central AI. The mean age was 66 ± 15 years, and the majority were female (61%). During the median follow-up time of 14 months, the total number of ED visits was 41 (in 24 patients) and 55 (in 30 patients) before and after the system’s implementation, respectively. The number of events requiring prompt hydrocortisone treatment was 14 and 15 before and after implementation, with 86% and 100% of these events receiving appropriate treatment, respectively. The median time from ED arrival to hydrocortisone administration significantly decreased from 123 (IQR: 87-208) minutes to 54 (IQR: 45-127) minutes before and after implementation (P = 0.03). Four adrenal crises (29%) occurred prior to glucocorticoid administration before the system implementation, while one (7%) occurred after the system was introduced (P = 0.34).

Conclusion: The implementation of a CDS system integrated into EHR significantly reduced the median time to hydrocortisone administration in AI patients presenting to EDs, decreased the frequency of preventable adrenal crises, and increased the proportion of patients receiving appropriate glucocorticoid administration. These findings underscore the role of CDS systems in enhancing the identification and management of AI and highlight their value in reducing delays and optimizing care in high-risk scenarios. Further studies with larger cohorts are warranted.