Non-Interruptive Alerts for Improving Use of Clinical Decision Rules

Study Overview
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Brief Summary
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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.

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

Conditions
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Pulmonary Embolism, Deep Vein Thrombosis, Minor Head Injury, Chest Pain, Neck Trauma

Intervention / Treatment
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* Other: Clinical Decision Rule Alerts


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Cluster randomized controlled trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention Group<br>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<br>* The<br>|
| No Intervention: Control Group<br>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?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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clinical decision support, clinical decision rules