Clinical trial NCT05232656: PREventing Adverse Events Post-Discharge Through Proactive Identification, Multidisciplinary Communication, and Technology
Official title: Impact of an Epic-integrated Safety Dashboard and Interactive Pre-discharge Checklist on Post-discharge Adverse Events
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Transitions of Care
General Medicine
Discharge Checklist
Adverse Event
Lead sponsor: Brigham and Women's Hospital
Sponsor class: OTHER
Collaborators: name: Crico
First posted: 2022-02-10
Enrollment: 268
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The goal of this study is to expand the use of previously developed patient safety dashboards and patient-centered discharge checklists to three general medicine units in an affiliated community hospital. The safety dashboard and interactive pre-discharge checklist are cognitive aids for clinicians and patients, respectively, that serve to facilitate early detection of patients at risk for preventable harm, including suboptimal discharge preparation. The aims of this study are to:

1. Enhance the safety dashboard and interactive pre-discharge checklist to include "smart" notifications for hospital-based clinicians when patients are at high risk for adverse events or have identified specific concerns related to discharge based on their checklist responses.
2. Expand intervention to general medical units at our community hospital-affiliate, BWFH.
3. Evaluate impact on post-discharge AEs for patients discharged from BWFH who are at risk for preventable harm and hospital readmission.

Detailed description: Our project proposes to address gaps in functionality of commercially available EHR systems through evaluation of novel, EHR-integrated HIT tools. We previously designed, developed, and implemented the patient safety dashboard and interactive pre-discharge checklist to engage clinicians and patients in systematically addressing safety threats in each of several domains. By integrating clinical data of several different types, these tools serve to reduce cognitive load and improve decision-making for clinicians. In this way, these tools represent a preventative intervention that mitigates risk in each domain by suggesting corrective action corresponding to institutional safety guidelines.

Studying the effectiveness of these tools on post-discharge outcomes will improve knowledge, technical capability, and clinical practice related to patient safety during transitions of care. Specifically, our project will advance scientific knowledge by quantifying the post-discharge impact of an intervention that changes clinical practice by enabling hospital-based clinicians to proactively institute corrective action for "at risk" patients who may require additional surveillance and supportive services during transitions. Also, we will establish the technical feasibility of spreading customized, third-party digital health applications that fill critical safety gaps in commercially available EHRs; expanding to a community hospital has clear implications for adoption and validation of this technology in different practice settings.

Eligibility criteria: Inclusion Criteria:

* Male or female, \>18 years of age, English-speaking
* Caregivers \>18 years of age designated by patient or patient's healthcare proxy
* Two or more patient safety risk factors

Exclusion Criteria:

- Non-English speaking patients for whom we cannot identify an English-speaking healthcare proxy

Primary outcomes:
measure: Potential Post-Discharge Adverse Events
timeFrame: 24 months
Secondary outcomes:
measure: Actual Post-Discharge Adverse Events
timeFrame: 24 months
measure: Preventable Post-Discharge Adverse Events
timeFrame: 24 months
Other outcomes:
Locations:
city: Boston
country: United States
facility: Brigham and Women's Hospital
state: Massachusetts
Study officials:
affiliation: Brigham and Women's Hospital
name: Anuj K Dalal, MD
role: PRINCIPAL_INVESTIGATOR
References: