Leveraging Electronic Health Record Tools to Improve the Evidence-Based Treatment of Children Hospitalized With Bronchiolitis

Not Applicable

Recruiting

• Conditions: Bronchiolitis

• Registration Number: NCT06932341
• Lead Sponsor: Johns Hopkins University

Brief Summary

The goal of this experimental study is to learn whether different types of best practice advisories (BPAs) that direct clinicians to reference clinical guidelines embedded in the electronic health record (EHR) increase the delivery of evidence-based care in children presenting to the hospital with bronchiolitis. The main questions it aims to answer are:

* Do BPAs improve clinicians' delivery of guideline-concordant care in bronchiolitis?

* Do interruptive BPAs improve guideline-concordant care of bronchiolitis more than non-interruptive BPAs?

Researchers will compare the treatment and outcomes of patients whose clinicians did not receive a BPA, to those whose clinicians received a non-interruptive BPA, to those whose clinicians received an interruptive BPA.

Patients will continue to receive standard hospital care for bronchiolitis.

Clinicians will:

* retain access to an EHR-embedded clinical guideline for bronchiolitis care

* be exposed to either no BPA, a non-interruptive BPA, or an interruptive BPA promoting the EHR-embedded clinical guideline (randomized per patient encounter)

Detailed Description

Bronchiolitis, a viral respiratory illness affecting infants and toddlers, is the most common reason children less than 2 years old are hospitalized. However, many children admitted with bronchiolitis receive unnecessary treatments that do not hasten recovery and may even cause harm. Despite evidence that the best treatment for bronchiolitis is supportive care (i.e. oxygen and hydration support), clinicians continue to overuse certain therapies, leading to longer hospital stays, higher costs, and increased stress for families.

The investigators will study the effects of BPAs, which are real-time alerts within the EHR. The BPAs in this study promote the use of an evidence-based care guideline for bronchiolitis that is embedded within the EHR. There are multiple BPA designs commonly used in EHRs: 1) interruptive BPAs, which require clinicians to interact with the alert to continue the clinician's workflow; and 2) non-interruptive BPAs, which appear as visual cues but do not require clinicians to alter workflows.

Study Timeline

• Study First Submitted: 2025-04-10
• Study First Submitted QC: 2025-04-10
• Study First Posted: 2025-04-17
• Status Verified: 2025-05
• Study Start: 2025-05-05
• Last Update Submitted: 2025-05-07
• Last Update Posted: 2025-05-08
• Primary Completion: 2026-05
• Study Completion: 2026-07

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 800

Inclusion Criteria

• Children <=24 months of age presenting to the emergency room and/or hospitalized (under observation or inpatient status) with bronchiolitis at one of three study sites.

Patient

Exclusion Criteria

• Current encounter is birth-encounter
• Currently hospitalized in an ICU
• Hospitalized with length of stay >14 days

Clinician Inclusion Criteria:

• Physicians and advanced practice providers entering the patient's chart or orders entry activity for Emergency Department (ED) and inpatient encounters

Clinician Exclusion Criteria:

• Physicians and advanced practice providers who do not enter the patient's chart or orders entry activity

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Composite score of guideline-discordant care per hospital encounter	From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients	Guideline-discordant care will be defined as a composite score incorporating number of chest X-rays, number of bronchodilator treatments, and numbers of hours spent on subtherapeutic rates of high-flow nasal cannula

Secondary Outcome Measures

Name	Time	Method
Hospital length of stay (hours)	From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
Duration of oxygen treatment (hours)	From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
Duration of high-flow nasal cannula treatment (hours)	From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
Number of Participants Transferred to intensive care unit	From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
Number of chest X-rays	From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
Number of bronchodilator treatments	From enrollment to the end of ED encounter (approximately <24 hours) for non-hospitalized patients; End of hospital stay (approximately 2-4 days) for hospitalized patients
Time spent on subtherapeutic rates of high-flow nasal cannula (hours)	From enrollment to the end of hospital stay, approximately 3 days	Subtherapeutic rates of high-flow nasal cannula will be defined as \<1 Liter/kilogram/minute
Number of Participants with Hospital readmission within 7 days	From enrollment to 7 days after hospital discharge

Trial Locations

Locations (3)

Johns Hopkins All Children's Hospital; 🇺🇸 Saint Petersburg, Florida, United States

Johns Hopkins Bayview Medical Center; 🇺🇸 Baltimore, Maryland, United States

Johns Hopkins Children's Center; 🇺🇸 Baltimore, Maryland, United States