Clinical Decision Support for a Multicenter Trial of Pediatric Head Trauma: Development, Implementation, and Lessons Learned.

TitleClinical Decision Support for a Multicenter Trial of Pediatric Head Trauma: Development, Implementation, and Lessons Learned.
Publication TypeJournal Article
Year of Publication2016
AuthorsTham E, Swietlik M, Deakyne S, Hoffman JM, Grundmeier RW, Paterno MD, Rocha BH, Schaeffer MH, Pabbathi D, Alessandrini EA, Ballard DW, Goldberg HS, Kuppermann N, Dayan PS
Corporate AuthorsPediatric Emergency Care Applied Research Network(PECARN)
JournalAppl Clin Inform
Volume7
Issue2
Pagination534-42
Date Published2016
ISSN1869-0327
Abstract

INTRODUCTION: For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinically-important traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial.

METHODS: Thirteen EDs participated in this trial. The 10 sites receiving the CDS intervention used the Epic(®) EHR. All sites implementing EHR-based CDS built the rules by using the vendor's CDS engine. Based on a sociotechnical analysis, we designed the CDS so that recommendations could be displayed immediately after any provider entered prediction rule data. One central site developed and tested the intervention package to be exported to other sites. The intervention package included a clinical trial alert, an electronic data collection form, the CDS rules and the format for recommendations.

RESULTS: The original PECARN head trauma prediction rules were derived from physician documentation while this pragmatic trial led each site to customize their workflows and allow multiple different providers to complete the head trauma assessments. These differences in workflows led to varying completion rates across sites as well as differences in the types of providers completing the electronic data form. Site variation in internal change management processes made it challenging to maintain the same rigor across all sites. This led to downstream effects when data reports were developed.

CONCLUSIONS: The process of a centralized build and export of a CDS system in one commercial EHR system successfully supported a multicenter clinical trial.

DOI10.4338/ACI-2015-10-CR-0144
Alternate JournalAppl Clin Inform
PubMed ID27437059
PubMed Central IDPMC4941858