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Using Informatics to Enhance Care of Older Emergency Department Patients

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ClinicalTrials.gov Identifier: NCT00297869
Recruitment Status : Completed
First Posted : March 1, 2006
Last Update Posted : October 5, 2016
Sponsor:
Information provided by (Responsible Party):
Indiana University ( Indiana University School of Medicine )

Brief Summary:

The subjects in this study are physicians working in the Wishard Emergency Department. The purpose of this study is to measure the extent to which information technology (i.e.-computers) improves emergency department care. The objective of our study is to evaluate the use of informatics in the emergency department and specifically to determine if computer reminder systems: 1) reduce the number of unsafe medications prescribed to older adults, 2) assist in more safely dosing of medications to adults of all ages, and 3) increase influenza immunization of eligible older patients in the emergency department.

Interventions: The interventions in this study are computer reminders. When releasing patients from the emergency department, physicians currently write all release orders, including prescriptions, on a computer order entry system that is linked to the Regenstrief Medical Record System. The computerized order entry system will be programmed so that physicians randomized (randomly placed) into the intervention group, the group that will receive the intervention, they will receive one of three types of reminders:

  1. The medication prescribed is generally considered unsafe for use in older patients. The reminder will then list appropriate alternatives for this medication.
  2. The dose of the prescribed medication is excessive and should be adjusted for the patient's creatinine clearance (or kidney function).
  3. This patient may be eligible for influenza vaccination.

The physician will then choose to order or disregard the recommendation. The computer system will automatically record what the physician selected to do. The general outcome of interest is the extent to which the electronic reminders successfully improved physician practice in the emergency department setting. This outcome will be compared to physicians who were randomized to the group that did not receive the reminders (the control group).


Condition or disease Intervention/treatment Phase
Elderly; Renal Insufficiency Procedure: Computer-Assisted Decision Support Not Applicable

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1350 participants
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Computer-Assisted Decision Support to Increase the Safety of Prescribing to Older Emergency Department Patients
Study Start Date : January 2005
Actual Primary Completion Date : June 2010
Actual Study Completion Date : June 2010

Arm Intervention/treatment
No Intervention: 1
Experimental: 2
Electronic warnings when providers prescribe a potentially inappropriate medication or an excessively dosed medication (based on estimated creatinine clearance)
Procedure: Computer-Assisted Decision Support
Electronic warnings when providers prescribe a potentially inappropriate medication or an excessively dosed medication (based on estimated creatinine clearance)




Primary Outcome Measures :
  1. Proportion of older ED patients who receive a potentially inappropriate medication [ Time Frame: During discharge home from the ED ]

Secondary Outcome Measures :
  1. Proportion of ED patients who receive an excessive dose of a medication that requires dosage adjustment for renal insufficiency [ Time Frame: During discharge home from the ED ]


Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • The subjects of this study will be physician providers and residents and medical students practicing under the supervision of a faculty emergency physician. Specific study subjects will include emergency medicine faculty physicians; emergency medicine and internal medicine residents; emergency medicine, surgery, and internal medicine interns; and medical students taking care of patients in our emergency department.

Exclusion Criteria:

  • We will not include the members of the research team in this study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00297869


Locations
United States, Indiana
Wishard Memorial Hospital
Indianapolis, Indiana, United States, 46202
Sponsors and Collaborators
Indiana University School of Medicine
Investigators
Principal Investigator: Kevin M. Terrell, DO, MS Indiana University School of Medicine

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Indiana University School of Medicine
ClinicalTrials.gov Identifier: NCT00297869     History of Changes
Other Study ID Numbers: 0311-04B
2004 Jahnigen Career Award
First Posted: March 1, 2006    Key Record Dates
Last Update Posted: October 5, 2016
Last Verified: October 2016

Additional relevant MeSH terms:
Emergencies
Renal Insufficiency
Disease Attributes
Pathologic Processes
Kidney Diseases
Urologic Diseases