title: Effect of a computerized alert on the management of hypokalemia in hospitalized patients.
abstract: 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.
authors.affiliation: Department of Social Medicine, Hadassah Medical Center, Hadassah-Hebrew University, PO Box 12000, Jerusalem 91120, Israel. ora@vms.huji.ac.il
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
authors.forename: Lois
authors.initials: L
authors.lastname: Gordon
authors.forename: David
authors.initials: D
authors.lastname: Berg
authors.forename: Abraham
authors.initials: A
authors.lastname: Israeli
mesh_terms: D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000628:therapy*; D007557:Israel; D007755:Laboratories, Hospital / Q000458:organization & administration*; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged