Abstract 33: Interventional Cardiologist Beliefs And Practices Before And After Implementation Of An Electronic Health Records-based Safe Contrast Limit Tool For Percutaneous Coronary Interventions

Background: Best Practice Advisories (BPAs) within electronic health record (EHR) systems can inform clinician decision-making and improve patient care. Their success depends on BPA content, clinical context, and staff buy-in. We recently implemented a safe contrast limit tool to reduce contrast-associated AKI (CA-AKI) after percutaneous coronary intervention (PCI). We evaluated the impact of this Contrast Limit BPA on interventional cardiologist attitudes and practices, and examined possible factors that influenced the BPA’s success.

Methods: Using a published model, we implemented a BPA in our Epic EHR that displayed calculated individualized safe contrast limits prior to PCI. Cardiologists were surveyed prior to and 9 months after BPA implementation. Pre-implementation questions covered beliefs about CA-AKI, practice patterns, knowledge of CA-AKI risk factors, and asked for safe contrast estimates for example patients. Post-implementation questions assessed practice patterns and the BPA’s perceived accuracy, efficacy, and utility. Survey data was compared to clinician PCI contrast use using logistic regression.

Results: We surveyed 8 clinicians pre-implementation and 10 post-implementation. Pre-implementation, 25% (2/8) reported using a contrast limit to make decisions about PCI and 12.5% (1/8) believed that they could improve their CA-AKI rates. In both their assessment of CA-AKI risk factors and contrast limit estimations, respondents often overestimated the contribution of age and diabetes while underestimating the influence of anemia and cardiogenic shock. Post-implementation, 30% (3/10) stated they were often surprised by the contrast limit and 80% (8/10) reported using the Contrast Limit when making PCI decisions. Clinicians who found the BPA to be clear and understandable or had catheterization lab staff discuss the limit prior to PCI had significantly lower odds of exceeding the safe contrast limit (OR=4.63, 95% CI [1.17, 18.35]; OR=6.76, 95% CI [1.81, 25.27]).

Conclusion: Clinicians often misestimated safe contrast limits and believed that there was little room for improvement in their CA-AKI rates. Despite initial skepticism, an EHR-based safe contrast limit BPA was frequently used and influenced contrast use.