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.
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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
440
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.
Northwell Health - Feinstein Institute for Medical Research
Manhasset, New York, United States
NYU Langone Health
New York, New York, United States
Baylor College of Medicine
Houston, Texas, United States
Percentage of CT scan orders that are guideline-concordant
Guideline-concordant is defined as CT scan orders with Wells' Score \>4 \["PE Likely"\] and/or d-dimer above upper limit of normal.
Time frame: Baseline (Month 12)
Percentage of CT scan orders that are guideline-concordant
Guideline-concordant is defined as CT scan orders with Wells' Score \>4 \["PE Likely"\] and/or d-dimer above upper limit of normal.
Time frame: End of intervention (Month 45)
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