Improving Recognition of Normotensive Cardiogenic Shock Through an Electronic Health Record Nudge.

BACKGROUND: Cardiogenic shock (CS) may occur despite preserved blood pressure, contributing to delayed recognition and escalation to specialized care. PROJECT RATIONALE: We implemented an interruptive electronic health record (EHR) alert designed to identify normotensive CS physiology and facilitate timely escalation to cardiac intensive care unit (CICU) consultation. PROJECT SUMMARY: We evaluated implementation of an interruptive EHR alert designed to identify patients with potential normotensive CS physiology at a tertiary academic medical center between December 2025 and March 2026. The alert incorporated an embedded escalation workflow allowing clinicians to directly order CICU consultation and/or repeat lactate measurement. Fifty alert triggers were analyzed. Clinician engagement with the alert workflow occurred in 14% of triggered alerts and was associated with higher rates of CICU consultation within 12 hours (42.9% vs 20.9%). Findings primarily demonstrated improved reliability of escalation decisions rather than changes in consultation timing once escalation occurred. TAKE-HOME MESSAGES: Normotensive CS is an under-recognized clinical phenotype associated with delayed escalation. EHR-based behavioral nudges embedded within clinician workflow may improve escalation reliability for high-risk patients with evolving shock physiology.