Non-Interruptive Alerts for Improving Use of Clinical Decision Rules

The Use of Non-Interruptive Alerts for Improving the Use of Clinical Decision Rules in the Emergency Department: A Cluster Randomized Controlled Trial

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.

Study Overview

• Status: Completed
• Conditions: Chest Pain; Deep Vein Thrombosis; Minor Head Injury; Pulmonary Embolism; Neck Trauma
• Intervention / Treatment: Other: Clinical Decision Rule Alerts

• Study Type: Interventional
• Enrollment (Actual): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Utah
    • Salt Lake City, Utah, United States, 84112
      • University Of Utah

Participation Criteria

Eligibility Criteria

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

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total clinical decision rule usage	Composite measure of total number of clinical decision rules used through the MDCalc Connect app.	During the intervention

Secondary Outcome Measures

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

Collaborators and Investigators

• Sponsor: University of Utah

Study record dates

Study Major Dates

• Study Start (Actual): February 18, 2021
• Primary Completion (Actual): November 18, 2021
• Study Completion (Actual): November 4, 2022

Study Registration Dates

• First Submitted: January 4, 2021
• First Submitted That Met QC Criteria: January 6, 2021
• First Posted (Actual): January 8, 2021

Study Record Updates

• Last Update Posted (Estimated): November 20, 2023
• Last Update Submitted That Met QC Criteria: November 16, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: clinical decision support; clinical decision rules
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Nervous System Diseases; Respiratory Tract Diseases; Lung Diseases; Pain; Neurologic Manifestations; Wounds and Injuries; Embolism and Thrombosis; Trauma, Nervous System; Embolism; Chest Pain; Thrombosis; Venous Thrombosis; Craniocerebral Trauma; Pulmonary Embolism
• Other Study ID Numbers: 00137874

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No