Key Information Can Influence Clinician Ordering of Brain CTs

Clinical Decision-Making Clinical Trial

Official title:

Effect of Clinical Decision Rules, Patient Cost and Malpractice Information on Clinician Brain CT Image Ordering: a Randomized Controlled Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03449862
• Other study ID #: Pro00054122
• Status: Completed
• Phase: N/A
• First received: February 14, 2018
• Last updated: February 22, 2018
• Start date: August 31, 2016
• Est. completion date: February 13, 2018

Study information

• Verified date: February 2018
• Source: Clemson University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 167
• Est. completion date: February 13, 2018
• Est. primary completion date: April 11, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 21 Years and older

Eligibility

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:

Related Conditions & MeSH terms

• Clinical Decision-Making

Intervention

Other:
• Simulation-based clinical decision on brain CT ordering
Clinicians asked to make decision on medical imaging for their simulated patient after presentation of clinical case then additional information. At each presentation of new information the clinician may modify their image order.

Locations

Country	Name	City	State
n/a

Sponsors (3)

Lead Sponsor	Collaborator
Clemson University	Emory University, Greenville Health System

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	brain CT medical image order	At each decision point clinician asked to decide on which image to order for patient among three choices: CT Head without/with contrast; CT Head without contrast; No medical imaging	30 days