Clinical Practice Guidelines and Impact of Audit and Feedback in the Emergency Department

Adherence to Clinical Practice Guidelines and the Impact of Audit and Feedback in the Emergency Department

This study will develop and test an intervention given to emergency medicine providers to improve adherence to clinical practice guidelines (CPGs) for pneumonia and sepsis.

Study Overview

• Status: Completed
• Conditions: Shock, Septic; Community Acquired Pneumonia
• Intervention / Treatment: Behavioral: Feedback with Peer Comparison

Detailed Description

This study will be performed at Denver Health Medical Center, a 477-bed urban, safety-net, acute-care hospital located in Denver, Colorado. The adult ED is staffed by board-certified emergency physicians at all times. These physicians supervise the care of all patients being managed by resident physicians, nurse practitioners, physician assistants, and medical students. Approximately 430 patients are admitted to the hospital from the ED each year with community-acquired pneumonia (CAP) and severe sepsis (SS).

Adherence to CPGs will be measured at the level of the attending emergency physician. All employed, attending emergency physicians working clinically in the adult ED at Denver Health Medical Center at the start of the study will be included.

The investigators will use a step-wedge design to randomize physicians into clusters. Randomization of physicians into clusters and randomization of clusters to intervention timing will occur one week prior to delivery of the intervention to cluster one. he intervention will consist of monthly audit and feedback on adherence to CPGs for CAP and SS. Once a cluster enters its first intervention month, all physicians in that cluster will receive an email detailing their adherence to both CAP and SS CPG for every month since the start of the study. Adherence to the entire CPG as well as each component of the CPG will be provided. In addition, physicians will be shown the median prevalence of adherence for all physicians as well as where their adherence ranks among their physician group. Lastly, in a separate secure email, physicians will be given patient identifiers (i.e., name, MRN, date of visit) for each patient that received non-adherent care and will be told which component of care was not adherent to the respective CPG so that they can review the case themselves, if desired.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 30 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Attending emergency medicine physicians working clinically in the Adult Emergency Department at Denver Health Medical Center at the start of the study.

Exclusion Criteria:

• None. All eligible physicians will be included.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Pre-Intervention; Delayed feedback and peer comparison
Experimental: Feedback with Peer Comparison; Individualized adherence feedback with peer comparison	Behavioral: Feedback with Peer Comparison; Email detailing adherence to CAP and SS CPG for every month since start of study. Physicians will be provided individualized feedback and given patient identifiers for each patient that received non-adherent care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Adherence to Community-Acquired Pneumonia and Severe Sepsis Clinical Practice Guidelines	Adherence will be determined via chart review of patients and will be measured by concordance with published clinical practice guidelines	30 days post-intervention and 60 days post-intervention

Collaborators and Investigators

• Sponsor: Denver Health and Hospital Authority
• Investigators: Principal Investigator: Stacy Trent, MD, Denver Health and Hospital Authority

Study record dates

Study Major Dates

• Study Start: July 1, 2015
• Primary Completion (Actual): April 1, 2016
• Study Completion (Actual): December 1, 2016

Study Registration Dates

• First Submitted: April 15, 2015
• First Submitted That Met QC Criteria: April 24, 2015
• First Posted (Estimate): April 27, 2015

Study Record Updates

• Last Update Posted (Estimate): February 2, 2017
• Last Update Submitted That Met QC Criteria: February 1, 2017
• Last Verified: February 1, 2017

More Information

Terms related to this study

• Keywords: Clinical Practice Guidelines
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Systemic Inflammatory Response Syndrome; Inflammation; Disease Attributes; Shock; Sepsis; Emergencies; Shock, Septic
• Other Study ID Numbers: 15-0400

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO