Clinical Practice Guidelines and Impact of Audit and Feedback in the Emergency Department

Shock, Septic Clinical Trial

Official title:

Adherence to Clinical Practice Guidelines and the Impact of Audit and Feedback in the Emergency Department

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02427048
• Other study ID #: 15-0400
• Status: Completed
• Phase: N/A
• First received: April 15, 2015
• Last updated: February 1, 2017
• Start date: July 2015
• Est. completion date: December 2016

Study information

• Verified date: February 2017
• Source: Denver Health and Hospital Authority
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study will develop and test an intervention given to emergency medicine providers to improve adherence to clinical practice guidelines (CPGs) for pneumonia and sepsis.

Description:

This study will be performed at Denver Health Medical Center, a 477-bed urban, safety-net, acute-care hospital located in Denver, Colorado. The adult ED is staffed by board-certified emergency physicians at all times. These physicians supervise the care of all patients being managed by resident physicians, nurse practitioners, physician assistants, and medical students. Approximately 430 patients are admitted to the hospital from the ED each year with community-acquired pneumonia (CAP) and severe sepsis (SS).

Adherence to CPGs will be measured at the level of the attending emergency physician. All employed, attending emergency physicians working clinically in the adult ED at Denver Health Medical Center at the start of the study will be included.

The investigators will use a step-wedge design to randomize physicians into clusters. Randomization of physicians into clusters and randomization of clusters to intervention timing will occur one week prior to delivery of the intervention to cluster one. he intervention will consist of monthly audit and feedback on adherence to CPGs for CAP and SS. Once a cluster enters its first intervention month, all physicians in that cluster will receive an email detailing their adherence to both CAP and SS CPG for every month since the start of the study. Adherence to the entire CPG as well as each component of the CPG will be provided. In addition, physicians will be shown the median prevalence of adherence for all physicians as well as where their adherence ranks among their physician group. Lastly, in a separate secure email, physicians will be given patient identifiers (i.e., name, MRN, date of visit) for each patient that received non-adherent care and will be told which component of care was not adherent to the respective CPG so that they can review the case themselves, if desired.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 24
• Est. completion date: December 2016
• Est. primary completion date: April 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 30 Years to 70 Years

Eligibility

Inclusion Criteria:

• Attending emergency medicine physicians working clinically in the Adult Emergency Department at Denver Health Medical Center at the start of the study.

Exclusion Criteria:

• None. All eligible physicians will be included.

Related Conditions & MeSH terms

• Community Acquired Pneumonia
• Emergencies
• Pneumonia
• Shock, Septic

Intervention

Behavioral:
• Feedback with Peer Comparison
Email detailing adherence to CAP and SS CPG for every month since start of study. Physicians will be provided individualized feedback and given patient identifiers for each patient that received non-adherent care.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Denver Health and Hospital Authority

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Adherence to Community-Acquired Pneumonia and Severe Sepsis Clinical Practice Guidelines	Adherence will be determined via chart review of patients and will be measured by concordance with published clinical practice guidelines	30 days post-intervention and 60 days post-intervention