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Key Information Can Influence Clinician Ordering of Brain CTs

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Clemson University

Status

Completed

Conditions

Clinical Decision-Making

Treatments

Other: Simulation-based clinical decision on brain CT ordering

Study type

Interventional

Funder types

Other

Identifiers

NCT03449862
Pro00054122

Details and patient eligibility

About

The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems.

Full description

Multi-center, double-blinded simulation-based randomized controlled trial. Following standardized clinical vignette presentation, clinicians made an initial imaging decision for the patient. This was followed by additional information on decision support rules, malpractice outcome review, and patient cost; each with opportunity to modify their initial order. The malpractice and cost information differed by assigned group to test the any temporal relationship. The simulation closed with a second vignette and an imaging decision.

Enrollment

167 patients

Sex

All

Ages

21+ years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

  • Clinician (physician, nurse practitioner, physician assistant) licensed to deliver health care.
  • Actively employed to deliver health care in the emergency department of Greenville health System (South Carolina) or Emory University (Georgia)

Exclusion criteria

  • None

Trial design

Primary purpose

Health Services Research

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Triple Blind

167 participants in 2 patient groups

LEGAL-COST
Experimental group
Description:
Clinicians were first presented malpractice case law summary information (which suggests clinician not likely to be sued for not ordering CT scan) then patient out-of-pocket cost information for brain CT image (which provides them insight into what the patient is likely to pay for the test)
Treatment:
Other: Simulation-based clinical decision on brain CT ordering
COST-LEGAL
Active Comparator group
Description:
Clinicians were first presented with patient out-of-pocket cost information for brain CT image (which provides them insight into what the patient is likely to pay for the test) then malpractice case law summary information (which suggests clinician not likely to be sued for not ordering CT scan)
Treatment:
Other: Simulation-based clinical decision on brain CT ordering

Trial documents
3

Trial contacts and locations

0

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Data sourced from clinicaltrials.gov

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