Pneumonia
Conditions
Keywords
Decision Support
Brief summary
Intermountain Health has developed a electronic decision support tool to help doctors provide the best care for pneumonia. The purpose of this study is to enhance the existing tool (called ePneumonia (electronic Pneumonia) or ePNa) so that it can be used at other institutions, and to test deployment of the tool at another institution's hospitals.
Detailed description
This study as funded by the AHRQ (Agency for Healthcare Research and Quality) involves making the current ePNa system a SMART on FHIR compatible application that will enable the same core software and processes to work across the Cerner and Epic electronic health record platforms. The investigators will then engage with emergency department providers and patients to improve user centered design, considering clinician preferences and feedback for use as well as patient needs for information. Finally, the investigators will evaluate the feasibility and acceptability via a pilot implementation trial of the interoperable ePNa platform at two Vanderbilt affiliated hospitals.
Interventions
OTHERePNa
Real-time, automated clinical decision support tool for pneumonia (called ePNa)
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Vanderbilt University
Stanford University
Nathan Dean
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
For the baseline database and assessment of clinical outcomes, all data will be pulled from the Epic Clarity data warehouse. * 2500 patients that presented to the Vanderbilt and Wilson county EDs who are \>= 18 years old will be identified by ICD-10 codes for pneumonia or acute respiratory failure or sepsis with secondary pneumonia codes for the baseline database. * An additional 2500 patients that presented to the Vanderbilt and Wilson county EDs who are \>= 18 years old will be identified by having had conventional PA (posteroanterior) and lateral or portable CXRs (chest X-rays), independent of ICD-10 codes. * During the one year pilot trial, patients seen in the 2 EDs, who are \>= 18 years old will be identified by ICD(International Classification of Diseases)-10 codes for pneumonia or acute respiratory failure or sepsis with secondary pneumonia codes (estimated to comprise 1800 patients).
Exclusion criteria
For all above patients: 1. Patients seen with a history of recent trauma. 2. Subsequent episodes of pneumonia from the same patient within the study period. 3. Patients directly admitted to hospice/comfort care. 4. Patients admitted to a non-study hospital for further care. 5. Patients transferred from outside hospitals. For the groups selected by ICD-10 pneumonia codes, an additional exclusion is: • Patients without radiographic evidence of pneumonia or with clear radiographic evidence for an alternative diagnosis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 14-day hospital-free days | 14 days after initial presentation to the emergency department | 14-day hospital-free days (a metric which captures outpatient disposition from the emergency department, secondary hospital admission, and length of stay) |
Secondary
| Measure | Time frame |
|---|---|
| 30-day all-cause mortality | At 30 days after initial ED presentation |
| ED length of stay (hours) | At ED discharge |
| ICU length of stay (days) | At ICU discharge |
| Number of patients admitted to floor who are subsequently transferred to ICU within 72 hours | At 72 hours after inpatient admission |
| Time from ED presentation to first antibiotic dose (minutes) | At time of first antibiotic dose |
Contacts
Primary ContactValerie Aston, MBA
Backup ContactDavid Tomer, MS
Outcome results
None listed