Pulmonary Embolism
Conditions
Brief summary
The purpose of this study is to examine the impact of the nudge implementation strategy (CDS tool + Nudge) on adoption of guideline-concordant CT ordering for pulmonary embolism (PE) in 10 EDs. The study will be a 33-month, rigorous, pragmatic, cluster-randomized, stepped wedge trial across 3 health systems and 10 EDs after collecting pre-implementation baseline data. The aim is to to demonstrate technological feasibility as well as examine efficacy of the nudges on adoption. The secondary objective is to decrease CT-ordering when it is not indicated.
Detailed description
Part 1 of the study included the collection of data. During the pre-implementation period each sites electronic health record (EHR) and baseline data was collected for 12 months. In Part 2, the study will examine the impact of the nudge implementation strategy (CDS tool + Nudge) on adoption of guideline-concordant CT ordering for PE in 10 EDs. Adoption outcomes data will be collected through EHR reporting systems.
Interventions
BEHAVIORALClinical Decision Support (CDS) tool with Nudges
The CDS tool with nudges provide information to providers to practice medicine in accordance with CT (computed tomography) ordering guidelines. The tool will only deploy when the provider is going against clinical guidelines and therefore provides a chance for the provider to reconsider their actions.
Sponsors
NYU Langone Health
National Heart, Lung, and Blood Institute (NHLBI)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Each emergency department (ED) will function as a control group (usual care) prior to implementation of the intervention.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. 18 years of older 2. A provider (MD, NP, PA) ordering CTs for evaluation of PE in adult patients present at study site Emergency Department (i.e., Northwell Health - Feinstein Institute for Medical Research, Baylor College of Medicine and NYU Langone Health).
Exclusion criteria
1\. A provider not present at the specified study sites.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of CT scan orders that are guideline-concordant | Baseline (Month 12) | Guideline-concordant is defined as CT scan orders with Wells' Score \>4 \["PE Likely"\] and/or d-dimer above upper limit of normal. |
Countries
United States
Contacts
CONTACTNatalie Henning
CONTACTLynn Xu
PRINCIPAL_INVESTIGATORSafiya Richardson, MD MPH
NYU Langone Health
Outcome results
None listed