Leveraging Electronic Health Record Tools to Improve the Evidence-Based Treatment of Children Hospitalized With Bronchiolitis

Johns Hopkins University

Status: Enrolling

Conditions: Bronchiolitis

Treatments: Other: Interruptive; Other: Non-interruptive

Study type: Interventional

Funder types: Other

Identifiers

NCT06932341

IRB00456658

Details and patient eligibility

About

The goal of this experimental study is to learn whether different types of best practice advisories (BPAs) that direct clinicians to reference clinical guidelines embedded in the electronic health record (EHR) increase the delivery of evidence-based care in children presenting to the hospital with bronchiolitis. The main questions it aims to answer are:

• Do BPAs improve clinicians' delivery of guideline-concordant care in bronchiolitis?
• Do interruptive BPAs improve guideline-concordant care of bronchiolitis more than non-interruptive BPAs?

Researchers will compare the treatment and outcomes of patients whose clinicians did not receive a BPA, to those whose clinicians received a non-interruptive BPA, to those whose clinicians received an interruptive BPA.

Patients will continue to receive standard hospital care for bronchiolitis.

Clinicians will:

• retain access to an EHR-embedded clinical guideline for bronchiolitis care
• be exposed to either no BPA, a non-interruptive BPA, or an interruptive BPA promoting the EHR-embedded clinical guideline (randomized per patient encounter)

Full description

Bronchiolitis, a viral respiratory illness affecting infants and toddlers, is the most common reason children less than 2 years old are hospitalized. However, many children admitted with bronchiolitis receive unnecessary treatments that do not hasten recovery and may even cause harm. Despite evidence that the best treatment for bronchiolitis is supportive care (i.e. oxygen and hydration support), clinicians continue to overuse certain therapies, leading to longer hospital stays, higher costs, and increased stress for families.

The investigators will study the effects of BPAs, which are real-time alerts within the EHR. The BPAs in this study promote the use of an evidence-based care guideline for bronchiolitis that is embedded within the EHR. There are multiple BPA designs commonly used in EHRs: 1) interruptive BPAs, which require clinicians to interact with the alert to continue the clinician's workflow; and 2) non-interruptive BPAs, which appear as visual cues but do not require clinicians to alter workflows.

Enrollment: 800 estimated patients

Sex: All

Ages: Under 24 months old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Patient Inclusion Criteria:

• Children <=24 months of age presenting to the emergency room and/or hospitalized (under observation or inpatient status) with bronchiolitis at one of three study sites.

Patient Exclusion Criteria:

• Current encounter is birth-encounter
• Currently hospitalized in an ICU
• Hospitalized with length of stay >14 days

Clinician Inclusion Criteria:

• Physicians and advanced practice providers entering the patient's chart or orders entry activity for Emergency Department (ED) and inpatient encounters

Clinician Exclusion Criteria:

• Physicians and advanced practice providers who do not enter the patient's chart or orders entry activity

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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800 participants in 3 patient groups

No BPA

No Intervention group

Description:

Clinicians will not be exposed to a BPA about the care of bronchiolitis. The participants will still have access to the EHR-embedded, evidence-based clinical guideline.

Interruptive BPA

Experimental group

Description:

Clinicians will be exposed to an interruptive BPA directing the clinician to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Treatment:

Other: Interruptive

Non-interruptive BPA

Experimental group

Description:

Clinicians will be exposed to an non-interruptive BPA directing the clinician to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Treatment:

Other: Non-interruptive