EHR Alert + Structured Communication for Pneumonia

(UP-CAPTAIn Trial)

Recruiting at 1 trial location

Overseen By Jonathan D Baghdadi, MD, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Jonathan Baghdadi

Must be taking: Antibiotics

Disqualifiers: Immunosuppression, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

100 Participants Needed

Trial Summary

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. However, since the study focuses on antibiotic use, you may need to adjust your antibiotic treatment based on the trial's findings.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on improving antibiotic use for pneumonia, so it's best to discuss your current medications with the trial team.

What data supports the idea that EHR Alert + Structured Communication for Pneumonia is an effective treatment?

The available research shows that electronic alert systems can improve communication of critical test results, which is important for patient safety. One study found that these systems help ensure that important test results are communicated effectively among healthcare providers. Another study highlighted that computer-generated alerts can prompt reviews of antibiotic use in hospitals, which can lead to better management of treatments. These findings suggest that EHR Alert + Structured Communication can enhance the effectiveness of pneumonia treatment by improving communication and management of care. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment Electronic alert, Structured communication of test results, Structured Communication of Test Results, Antimicrobial Stewardship Team Intervention for pneumonia?

Research shows that electronic alert systems can improve communication of critical test results, which is important for patient safety. Additionally, computer-generated alerts prompting review of antibiotic use have been shown to impact antibiotic use in hospitals, suggesting that similar systems could help manage pneumonia treatment effectively. ^{1 2 3 4 5}

What safety data exists for EHR alerts and structured communication for pneumonia?

The research does not directly address safety data for EHR alerts and structured communication specifically for pneumonia. However, it discusses the use of electronic alert systems in healthcare settings, highlighting their role in improving communication of critical test results and medication safety. The studies suggest that while these systems can enhance patient safety by ensuring timely communication and monitoring, there is a risk of alert fatigue among clinicians, which could potentially impact their effectiveness. ^{3 4 6 7 8}

Is the EHR Alert + Structured Communication for Pneumonia safe for humans?

The research articles focus on the effectiveness and communication aspects of electronic alert systems in healthcare, but they do not provide specific safety data for humans regarding the EHR Alert + Structured Communication for Pneumonia. ^{3 4 6 7 8}

Is the treatment in the trial 'EHR Alert + Structured Communication for Pneumonia' promising?

Yes, the treatment is promising because electronic health record (EHR) alerts can improve communication and ensure important health information is delivered to healthcare providers. This can lead to better diagnosis and treatment, making it a valuable tool in managing pneumonia. ^{3 6 8 9 10}

How does the EHR Alert + Structured Communication treatment for pneumonia differ from other treatments?

The EHR Alert + Structured Communication treatment for pneumonia is unique because it uses electronic health record (EHR) alerts to improve communication and coordination among healthcare providers, ensuring timely and effective management of pneumonia. This approach focuses on enhancing the workflow and communication processes rather than directly altering the medical treatment itself. ^{3 6 8 9 10}

What is the purpose of this trial?

The goal of this prospective randomized study is to improve antibiotic use among hospitalized patients with suspected pneumonia. An alert was built into the electronic health record to guide use of diagnostic testing based on probability of bacterial pneumonia. Patients with test results suggesting viral infection will be randomized to either: (1) receive a structured communication from the antimicrobial stewardship team to de-escalate antibiotics or (2) usual care.

Research Team

Daniel J. Morgan, MD, MS

Principal Investigator

University of Maryland, Baltimore

Eligibility Criteria

This trial is for adult patients at two Maryland medical centers who are hospitalized with suspected community-acquired respiratory infections and have test results that may indicate a viral infection. They must be on antibiotics and not just have cold symptoms.

Inclusion Criteria

I am an adult at UMMC or UMMC-Midtown prescribed antibiotics for a suspected lung infection.

Protocol-based diagnostic testing indicates a potential viral infection, confirmed by either a positive molecular test result or low procalcitonin value.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Randomization and Intervention

Patients with test results suggesting viral infection are randomized to receive either structured communication from the antimicrobial stewardship team or usual care.

3 days

In-hospital

Follow-up

Participants are monitored for safety outcomes including length of stay, readmissions, hospital-free days, and mortality.

90 days

Treatment Details

Interventions

• Electronic alert
• Structured communication of test results

Trial Overview The study tests if an electronic alert in the health record, advising doctors based on the likelihood of bacterial pneumonia, can improve antibiotic use. Patients flagged as likely having a virus will either get special advice to reduce antibiotics or continue with standard care.

Participant Groups

Group I: Electronic alert plus structured communication of test results Experimental Treatment 2 Interventions

An electronic health record alert will guide diagnostic testing for pneumonia. For patients with low or moderate probability of bacterial pneumonia, test results will be communicated to the primary team with guidance to consider discontinuing or de-escalating antibiotics.

Group II: Electronic alert without structured communication of test results Active Control 1 Intervention

An electronic health record alert will guide diagnostic testing for pneumonia. The primary care team will access and interpret test results and decide upon composition and duration of antimicrobial without external guidance.

Who Is Running the Clinical Trial?

Jonathan Baghdadi

Lead Sponsor

Trials

1

Recruited

100+

Centers for Disease Control and Prevention

Collaborator

Trials

902

Recruited

25,020,000+

Findings from Research

The adaptation of an electronic referral application for antimicrobial stewardship significantly increased the completion rate of antimicrobial round reviews from 59% to 88% over 12 months, indicating improved efficiency in the referral process.

There was a notable reduction in the use of broad-spectrum antibiotics, such as piperacillin/tazobactam and fluoroquinolones, alongside a decrease in the proportion of ignored advice from 18% to 8.5%, demonstrating enhanced adherence to clinical recommendations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds. Rawlins, MDM., Raby, E., Sanfilippo, FM., et al.[2022]

An active communication method using on-call pharmacy residents significantly reduced the time to optimal therapy for patients with positive blood cultures compared to a passive electronic notification system, with median times of 23.4 hours versus 42.2 hours and 45.9 hours, respectively.

The active approach also led to faster discontinuation of empiric antibiotics in cases of contamination, with an immediate response in the active group compared to 17.7 hours and 7.2 hours in the control and passive groups, highlighting its effectiveness in improving antibiotic stewardship.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of active versus passive methods of responding to rapid diagnostic blood culture results. Chandler, EL., Wallace, KL., Palavecino, E., et al.[2022]

The implementation of the Alert Notification of Critical Results (ANCR) system significantly reduced the proportion of critical radiology reports lacking documented communication between care providers, decreasing from 19% to 5% over four years (2009-2014).

There was no increase in the communication of non-critical results after the ANCR system was implemented, indicating that the system did not lead to overuse for non-critical findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis. Lacson, R., O'Connor, SD., Sahni, VA., et al.[2018]

In a survey of 54 hospitalized patients receiving antimicrobial therapy, 83% were informed they were on antimicrobials, but only 18% were told about potential side effects and 36% knew the duration of treatment, indicating significant gaps in communication.

The study revealed that 62% of patients desired more information about their therapy, highlighting the need for improved communication strategies and quality improvement actions to enhance patient understanding and satisfaction regarding antimicrobial treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing patient understanding of their antimicrobial treatment: How are we doing and how might we improve? Yeoh, K., George, C., Rajkhowa, A., et al.[2021]

A computer-generated alert system for reviewing antibiotic prescriptions in hospitals led to a significant reduction in antibiotic use, with a 26.5% decrease in the number of days antibiotics were prescribed after intervention.

The alert prompted direct counselling for 51.7% of flagged prescriptions, resulting in modifications such as shortening treatment duration or withdrawing unnecessary antibiotics, and physicians complied with these recommendations 80% of the time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of a computer-generated alert system prompting review of antibiotic use in hospitals. Lesprit, P., Duong, T., Girou, E., et al.[2009]

A study of 28 primary care providers at a Veterans Affairs Medical Center revealed significant variability in how they manage electronic alerts for critical diagnostic test results, with nearly half not utilizing any alert-management features.

Providers with lower rates of timely follow-up often relied on manual scanning and clinical judgment rather than using available tools, suggesting that improving knowledge and standardizing alert-management strategies could enhance follow-up rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Provider management strategies of abnormal test result alerts: a cognitive task analysis. Hysong, SJ., Sawhney, MK., Wilson, L., et al.[2021]

The implementation of 'stealth' alerts in electronic health records led to a significant increase in anticoagulation monitoring, with 39% of patients completing monitoring within 5 days after co-prescribing a medication that interacts with warfarin, compared to 34% before the alerts were introduced.

This innovative approach directs alerts to a specialized anticoagulation management service rather than the prescribing clinicians, reducing alert fatigue and improving patient safety through better monitoring of potential drug interactions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Stealth" alerts to improve warfarin monitoring when initiating interacting medications. Koplan, KE., Brush, AD., Packer, MS., et al.[2021]

Primary care practitioners (PCPs) received an average of 56.4 asynchronous electronic health record (EHR) alerts per day, which significantly contributes to their workload.

On average, PCPs spent about 49 minutes each day processing these alerts, highlighting the need for further investigation into the effectiveness and management of such alert systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Notifications received by primary care practitioners in electronic health records: a taxonomy and time analysis. Murphy, DR., Reis, B., Sittig, DF., et al.[2022]

The study involving 28 ED triage nurses and over 39,000 patients found that a passive EHR alert did not significantly increase the utilization of triage protocols for diagnostic testing in emergency settings.

Despite some increases in protocol implementation after the intervention, the overall benefits of using EHR alerts were minimal, suggesting that more rigorous studies are needed to optimize alert systems for improving patient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electronic alerts for triage protocol compliance among emergency department triage nurses: a randomized controlled trial. Holmes, JF., Freilich, J., Taylor, SL., et al.[2018]

The study aims to improve electronic communication in the Veterans Health Administration's EMR by analyzing how abnormal test results, referral requests, and prescriptions are communicated, highlighting the importance of effective communication beyond just information transfer.

Using a human factors engineering approach, the research will identify potential errors in electronic communication processes and gather insights from focus groups to redesign work systems for better healthcare outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving outpatient safety through effective electronic communication: a study protocol. Hysong, SJ., Sawhney, MK., Wilson, L., et al.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds. [2022]

2. England pubmed.ncbi.nlm.nih.gov

A comparison of active versus passive methods of responding to rapid diagnostic blood culture results. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis. [2018]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Assessing patient understanding of their antimicrobial treatment: How are we doing and how might we improve? [2021]

5. England pubmed.ncbi.nlm.nih.gov

Impact of a computer-generated alert system prompting review of antibiotic use in hospitals. [2009]

6. England pubmed.ncbi.nlm.nih.gov

Provider management strategies of abnormal test result alerts: a cognitive task analysis. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

"Stealth" alerts to improve warfarin monitoring when initiating interacting medications. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Notifications received by primary care practitioners in electronic health records: a taxonomy and time analysis. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Electronic alerts for triage protocol compliance among emergency department triage nurses: a randomized controlled trial. [2018]

10. England pubmed.ncbi.nlm.nih.gov

Improving outpatient safety through effective electronic communication: a study protocol. [2021]