Abstract T P294: An Electronic Medical Record Order Set Change To Increase In-Hospital Statin Use In Ischemic Stroke Is Associated With Improved Post-Stroke Outcomes

Abstract

Introduction: In-hospital statin use is associated with improved ischemic stroke outcomes. Here we examine the impact of an electronic order set change to increase statin use during stroke hospitalization. Methods: An electronic order set for ischemic stroke admission across 20 hospitals was changed from an ‘opt-in’ mode of statin ordering to an ‘opt-out’ mode of statin ordering. We performed interrupted time series analysis (2 years before and after), examining the impact on in-hospital statin use and on patient outcomes. We examined features of inpatient statin use as well as death by 90 days and discharge to home or inpatient rehabilitation. We examined two subpopulations: severe stroke (mNIHSS 21-42) and less severe stroke (mNIHSS 1-20). We ruled out seasonality, autoregressive effects, and moving average effects for in each of the time series. Findings: We analyzed electronic records for 8993 patients. Measures of inpatient statin use increased when the order set change went live: high dose statin use increased by a factor of 2.5 (2.0-3.1) and statins within 8 hours by a factor of 1.8 (1.5-2.0) (P <0.001). For patients with less severe strokes, the increase in overall statin use in-hospital was not significant (86.2% before vs. 88.4% after). However, among patients with higher stroke severity, there was a significant increase in statin prescription (57.6% before vs. 62.8% after), and this increase was associated with a decline in the odds of death within 90 days by a factor of 0.53 (0.36-0.79) and a 1.8 (1.1-3.0) increase in the odds of being home or in inpatient rehabilitation within 2 weeks. Discussion: A simple change in an electronic medical record system led to a significant increase in statin prescription during ischemic stroke hospitalization, particularly among patients with more severe stroke. This increase in statin prescription was associated with improved post-stroke outcomes.