Non-Interruptive Alerts for Improving Use of Clinical Decision Rules

Not Applicable

Completed

• Conditions: Pulmonary Embolism; Deep Vein Thrombosis; Minor Head Injury; Chest Pain; Neck Trauma
• Interventions: Other: Clinical Decision Rule Alerts

• Registration Number: NCT04702308
• Lead Sponsor: University of Utah

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.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2021-01-04
• Study First Submitted QC: 2021-01-06
• Study First Posted: 2021-01-08
• Study Start: 2021-02-18
• Primary Completion: 2021-11-18
• Study Completion: 2022-11-04
• Status Verified: 2023-11
• Last Update Submitted: 2023-11-16
• Last Update Posted: 2023-11-18

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 70

Inclusion Criteria

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

Patient

Exclusion Criteria

• None

  • A full list of the qualifying chief complaints is provided in Appendix A of the full research protocol.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention Group	Clinical Decision Rule Alerts	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.

Primary Outcome Measures

Name	Time	Method
Total clinical decision rule usage	During the intervention	Composite measure of total number of clinical decision rules used through the MDCalc Connect app.

Secondary Outcome Measures

Name	Time	Method
d-dimer tests	During the intervention	Total number of d-dimer blood tests ordered
Delta troponin tests	During the intervention	Total number of times two or more troponin tests were ordered
Admission rate	During the intervention	Hospital admission rate
Individual clinical decision rule usage	During the intervention	Number of uses of individual clinical decision rules measured through the MDCalc Connect app.
Computed tomography c-spine studies	During the intervention	The total number of computed tomography c-spine without contrast studies ordered
Lower extremity ultrasound	During the intervention	The total number of lower extremity ultrasound studies ordered
Computed tomography pulmonary angiography studies	During the intervention	The total number of computed tomography pulmonary angiography studies ordered
Computed tomography head studies	During the intervention	The total number of computed tomography head without contrast studies ordered
Emergency department bounceback rate.	Up to 30 days after the intervention	30-day emergency department return visit (or "bounceback") rate

Trial Locations

Locations (1)

University of Utah; 🇺🇸 Salt Lake City, Utah, United States