Pilot Trial of a Clinical Decision-Support App for Managing Emergencies Among Clinicians in a Rural Ugandan Hospital

NCT07257705 | Completed

• 2 other identifiers: UNIMIB-972-OASES2025-CONT-142-BiUniCrowd-OASES
• Study Type: interventional
• Target: 15
• Locations: 1 country
• Sites: 1

Brief Summary

This study is testing a new mobile application called the OASES App, developed by the University of Milano-Bicocca. The App is designed to help frontline clinicians (nurses, clinical officers, and nursing assistants) provide faster and more accurate emergency care for patients with life-threatening conditions such as severe diarrhea, breathing difficulties, and seizures. The OASES App guides clinicians step by step through internationally recognized emergency care guidelines, including triage, diagnosis, and treatment recommendations. It is intended to be used offline on a tablet, making it suitable for rural hospitals with limited resources. This is a pilot study to understand whether the App improves the way clinicians manage simulated emergency cases compared to standard practice. About 16 clinicians at Dr. Ambrosoli Memorial Hospital, Kalongo, Uganda will take part in structured simulation exercises using realistic patient scenarios. Each participant will manage cases with and without the App, so that the two approaches can be compared. The main goal is to evaluate whether the App helps clinicians follow evidence-based guidelines more consistently. Other goals include measuring accuracy of triage, diagnosis, and treatment decisions, as well as the time needed to complete cases and clinicians' perceptions of usability, trust, and feasibility. No real patients will be involved in this study. All scenarios are simulations conducted in a safe, controlled environment. The results will help refine the App and inform the design of a larger study in the future.

Conditions

Diarrhea Infectious; Seizures; Emergency Care; Clinical Decision Support Systems; Rural Health; Dyspnea

Keywords

OASES App; Clinical Decision Support Systems; Emergency Care; Simulation Trial

Outcome Measures

Primary Outcomes (1)

• Guideline-Adherent Management of Simulated Emergency Cases

  Proportion of pre-specified, evidence-based diagnostic and treatment actions (critical management steps) correctly performed by participants during simulated scenarios of diarrhea, dyspnea, and seizures. Performance will be scored against gold-standard checklists derived from WHO and Uganda clinical guidelines by two independent blinded assessors. The outcome is expressed as a proportion (0-1) of guideline-consistent critical management actions completed.

  Immediately after completion of each simulation scenario

Secondary Outcomes (7)

• Triage Accuracy

  Immediately after completion of each simulation scenario

• Disposition Appropriateness

  Immediately after completion of each simulation scenario

• Diagnostic Accuracy

  Immediately after completion of each simulation scenario

• Guideline-Adherent Evaluation (Process Quality)

  Immediately after completion of each simulation scenario

• Time to Case Completion

  Immediately after completion of each simulation scenario

Study Arms (2)

OASES App-Assisted Emergency Care

EXPERIMENTAL

Participants will use the OASES tablet-based clinical decision-support system to manage simulated emergency cases of diarrhea, dyspnea, and seizures. The App incorporates the WHO Interagency Integrated Triage Tool (IITT) and evidence-based algorithms from WHO and Ugandan guidelines. It provides real-time guidance for triage, diagnosis, and treatment steps, while also collecting structured data. Before use, participants receive a short orientation to the App but no formal training.

Other: OASES App

Standard Practice Emergency Care

NO INTERVENTION

Participants will manage the same simulated emergency cases of diarrhea, dyspnea, and seizures without the OASES App, using their usual knowledge, clinical experience, and available resources. Standard reference materials, including paper-based WHO Interagency Integrated Triage Tool (IITT) and Uganda Clinical Guidelines, are accessible. This arm reflects routine practice in the outpatient department of Dr. Ambrosoli Memorial Hospital.

Interventions

OASES App OTHER

The OASES App is a tablet-based digital clinical decision-support system (CDSS) developed in 2025 by the University of Milano-Bicocca. The App digitizes validated WHO- and Uganda guideline-based triage and emergency care algorithms, including the Interagency Integrated Triage Tool (IITT) and condition-specific pathways for diarrhea, dyspnea, and seizures in both adults and children. It provides step-by-step guidance for frontline clinicians during emergency case management and simultaneously collects structured clinical data. The App is designed for offline use in rural hospitals with limited infrastructure. In this trial, participants receive a brief orientation but no formal training before using the App during simulation scenarios.

Also known as: Organization for the Advancement and Support of Emergency Systems App, OASES Clinical Decision-Support App

OASES App-Assisted Emergency Care

Eligibility Criteria

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

You may qualify if:

• Nurses, clinical officers, or nursing assistants currently employed in the outpatient department (OPD) of Dr. Ambrosoli Memorial Hospital.
• Age ≥18 years.
• Willing and able to provide written informed consent.
• Available to participate in both simulation sessions.

You may not qualify if:

• Individuals unable or unwilling to participate in both scheduled simulation sessions.
• Individuals not currently employed in the OPD of Dr. Ambrosoli Memorial Hospital.

Sponsors & Collaborators

• University of Milano Bicocca: lead

Study Sites (1)

Dr. Ambrosoli Memorial Hospital Kalongo

Kalongo, Agago District, 47, Uganda

Location

Related Links

• OASES Project Website

MeSH Terms

Conditions

Dysentery; Seizures; Dyspnea

Interventions

Organizations

Condition Hierarchy (Ancestors)

Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Intestinal Diseases; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Respiration Disorders; Respiratory Tract Diseases; Signs and Symptoms, Respiratory

Intervention Hierarchy (Ancestors)

Health Care Economics and Organizations

Study Officials

• Michele Bombelli, MD

  University of Milano Bicocca

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Independent outcome assessors who score participants' responses against gold-standard checklists are blinded to study allocation. They do not know whether the responses come from the OASES App-assisted or standard practice sessions. Participants, facilitators, and investigators are not masked due to the nature of the simulation design.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor, School of Medicine and Surgery, University of Milano-Bicocca

Model Details: This study uses a randomized, stratified crossover simulation design. Each participant manages standardized emergency scenarios in two periods: one using the OASES App (intervention) and one using standard practice (control). The order of conditions is randomized with permuted blocks, stratified by cadre (nurse/nursing assistant vs. clinical officer) to ensure balance. A washout period of at least three days separates the two periods to minimize learning and carryover effects. Matched pairs of cases (A and B sets) are used to ensure comparable content between periods, and within each period the case order is randomized.

Study Record Dates

• First Submitted: November 18, 2025
• First Posted: December 2, 2025
• Study Start: February 6, 2026
• Primary Completion: February 14, 2026
• Study Completion: February 14, 2026
• Last Updated: February 24, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

UG (1)