Non-Interruptive Alerts for Improving Use of Clinical Decision Rules

• ClinicalTrials.gov Identifier: NCT04702308
• Recruitment Status: Enrolling by invitation
• First Posted: January 8, 2021
• Last Update Posted: January 11, 2022
• Sponsor: University of Utah
• Information provided by (Responsible Party): Keaton Morgan, University of Utah

Study Description

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.

Condition or disease	Intervention/treatment	Phase
Pulmonary Embolism; Deep Vein Thrombosis; Minor Head Injury; Chest Pain; Neck Trauma	Other: Clinical Decision Rule Alerts	Not Applicable

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 240 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Cluster randomized controlled trial
• Masking: None (Open Label)
• Primary Purpose: Diagnostic
• Official Title: The Use of Non-Interruptive Alerts for Improving the Use of Clinical Decision Rules in the Emergency Department: A Cluster Randomized Controlled Trial
• Actual Study Start Date: February 18, 2021
• Actual Primary Completion Date: November 18, 2021
• Estimated Study Completion Date: July 2022

Arms and Interventions

Arm	Intervention/treatment
Experimental: Intervention Group; 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; The
No Intervention: Control Group; 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.

Outcome Measures

Primary Outcome Measures :

1. Total clinical decision rule usage [ Time Frame: During the intervention ]
   Composite measure of total number of clinical decision rules used through the MDCalc Connect app.

Secondary Outcome Measures :

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

Eligibility Criteria

• Ages Eligible for Study: 16 Years and older (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Patient 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.

Contacts and Locations

Locations

United States, Utah

University of Utah

Salt Lake City, Utah, United States, 84112

Sponsors and Collaborators

University of Utah

  Study Documents (Full-Text)

Documents provided by Keaton Morgan, University of Utah:

Study Protocol and Statistical Analysis Plan  [PDF] November 17, 2020

More Information

• Responsible Party: Keaton Morgan, Postdoctoral Fellow, University of Utah
• ClinicalTrials.gov Identifier: NCT04702308
• Other Study ID Numbers: 00137874
• First Posted: January 8, 2021
• Last Update Posted: January 11, 2022
• Last Verified: January 2022

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Keaton Morgan, University of Utah:

clinical decision support; clinical decision rules

Additional relevant MeSH terms:

Pulmonary Embolism; Craniocerebral Trauma; Thrombosis; Embolism; Venous Thrombosis; Chest Pain; Embolism and Thrombosis; Vascular Diseases; Cardiovascular Diseases; Lung Diseases; Respiratory Tract Diseases; Pain; Neurologic Manifestations; Trauma, Nervous System; Nervous System Diseases; Wounds and Injuries