PAINED: Project Addressing INequities in the Emergency Department

Children's National

Status: Enrolling

Conditions: Appendicitis; Bias, Racial; Pain; Fractures, Bone

Treatments: Behavioral: Department-level audit and feedback and electronic health record-embedded clinical decision support

Study type: Interventional

Funder types: Other

Identifiers

NCT05488080

FP00005944 / 1R61DK135406 - 01

Details and patient eligibility

About

Racial and ethnic inequities in health care quality have been described across a broad range of clinical settings, patient populations, and outcomes. Our overarching goal is to eradicate health care inequities through evidence-based interventions. The objectives of this proposal are to develop and test the impact of two interventions on overcoming clinician implicit bias and mitigating inequities in the management of pain among children seeking care in the emergency department for the treatment of appendicitis or long bone fractures.

Enrollment: 22,032 estimated patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• All Children's National Hospital Emergency Department clinicians
• Patients 0-21 years with symptoms suggestive of appendicitis or long bone fracture

Exclusion criteria

• Emergency Severity Index (ESI 1)

Trial design

Primary purpose: Health Services Research

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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22,032 participants in 1 patient group

Department-level audit and feedback and electronic health record-embedded clinical decision support

Experimental group

Description:

Clinicians will receive monthly pooled, department-level 'Equity Report Cards' that will provide aggregate information on clinical data stratified by patient race/ethnicity. Subsequently, for all visits that may be related to appendicitis or long bone fracture, clinicians will then receive real-time, electronic health record-embedded clinical decision support regarding pain management.

Treatment:

Behavioral: Department-level audit and feedback and electronic health record-embedded clinical decision support