Non-Interruptive Alerts for Improving Use of Clinical Decision Rules

NCT04702308 | Completed

• 1 other identifier: 00137874
• Study Type: interventional
• Target: 70
• Locations: 1 country
• Sites: 1

Brief Summary

This study is an extension of a planned quality improvement project that aims to promote standard of care by increasing the use of evidence-based clinical decision rules amongst emergency medicine providers in the University of Utah Emergency Department. Patient-specific information from the EHR will be used to recommend the use of relevant clinical decision rules to emergency medicine providers at the point-of-care. These recommendations will be in the form of non-interruptive alerts with one-click access to the suggested decision rules through the MDCalc Connect EHR add-on application. Specific aims of the study are to determine if 1) patient-specific non-interruptive alerts increase the use of clinical decision rules amongst emergency medicine providers and 2) an increase in the use of clinical decision rules affects provider ordering habits.

Conditions

Pulmonary Embolism; Deep Vein Thrombosis; Minor Head Injury; Chest Pain; Neck Trauma

Keywords

clinical decision support; clinical decision rules

Outcome Measures

Primary Outcomes (1)

• Total clinical decision rule usage

  Composite measure of total number of clinical decision rules used through the MDCalc Connect app.

  During the intervention

Secondary Outcomes (9)

• Individual clinical decision rule usage

  During the intervention

• Computed tomography pulmonary angiography studies

  During the intervention

• Computed tomography head studies

  During the intervention

• Computed tomography c-spine studies

  During the intervention

• Lower extremity ultrasound

  During the intervention

Study Arms (2)

Intervention Group

EXPERIMENTAL

The intervention will contain two components: 1) a non-interruptive best practice advisory (BPA) in the Epic Storyboard and 2) a default suggested calculator tab in the MDCalc Connect app. Six clinical decision rules will be included: Canadian CT Head Rule, Canadian C-spine Rule, HEART Score, PERC Rule, Wells' PE Criteria and Wells' DVT Criteria. Predefined criteria based on chief complaint, patient age and vital signs will be used to determine when a decision rule may be relevant in a patient encounter. When a patient meets all of the predefined criteria, the intervention will be triggered.

Other: Clinical Decision Rule Alerts

Control Group

NO INTERVENTION

The control group will be usual care. Specifically, providers in the control group will not receive the clinical decision rule alert or the default suggested calculator tab in the MDCalc Connect app. The control group providers will have access to the MDCalc Connect app in its standard form and functionality.

Interventions

Clinical Decision Rule Alerts OTHER

The

Intervention Group

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• years of age or older
• Qualifying chief complaint\*

You may not qualify if:

• None
• A full list of the qualifying chief complaints is provided in Appendix A of the full research protocol.

Sponsors & Collaborators

• University of Utah: lead

Study Sites (1)

University of Utah

Salt Lake City, Utah, 84112, United States

Location

MeSH Terms

Conditions

Pulmonary Embolism; Venous Thrombosis; Craniocerebral Trauma; Chest Pain

Condition Hierarchy (Ancestors)

Lung Diseases; Respiratory Tract Diseases; Embolism; Embolism and Thrombosis; Vascular Diseases; Cardiovascular Diseases; Thrombosis; Trauma, Nervous System; Nervous System Diseases; Wounds and Injuries; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Postdoctoral Fellow

Model Details: Cluster randomized controlled trial

Study Record Dates

• First Submitted: January 4, 2021
• First Posted: January 8, 2021
• Study Start: February 18, 2021
• Primary Completion: November 18, 2021
• Study Completion: November 4, 2022
• Last Updated: November 18, 2023

Record last verified: 2023-11

Locations

US (1)