System Level Informatics to Improve Triage Practices for Sickle Cell Disease Vaso-Occlusive Crisis: A Cluster Randomized Controlled Trial.
Clinical decision support
EHR alert
Emergency nursing
Guidelines
Pain
Sickle cell disease
Triage
Journal
Journal of emergency nursing
ISSN: 1527-2966
Titre abrégé: J Emerg Nurs
Pays: United States
ID NLM: 7605913
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
25
08
2020
revised:
28
04
2021
accepted:
21
05
2021
pubmed:
25
7
2021
medline:
26
11
2021
entrez:
24
7
2021
Statut:
ppublish
Résumé
National Heart Lung and Blood Institute guidelines for the treatment of vaso-occlusive crisis among people with sickle cell disease in the emergency department recommend assigning an emergency severity index of 2 at triage. However, patients with sickle cell disease often do not receive guideline-concordant care at triage. To address this gap, a decision support tool was developed, in the form of a text banner on the triage page in the electronic health record system, visible to triage nurses. A prospective quality improvement initiative was designed where the emergency severity index clinical decision support tool was deployed to a stratified random sample of emergency department triage nurses to receive the banner (n = 24) or not to receive the banner (n = 27), reminding them to assign the patient to emergency severity index category 2. The acceptability of the emergency severity index clinical decision support tool was evaluated with the Ottawa Acceptability of Decision Rules Instrument. Descriptive and bivariate (chi-square test) statistics were used to characterize the study's primary outcome, proportion of visits assigned an emergency severity index of 2 or higher. A generalized linear mixed model with clustering at the level of the triage nurse was performed to test the association between the banner intervention and triage practices. A total of 384 ED visits were included for analysis. Before study initiation, the percentage of sickle cell disease patients' visits with the proper emergency severity index assignment at triage was 37.04%. After initiation, the proportion of sickle cell disease patients' visits with an emergency severity index of 2 or higher triaged by nurses in the intervention group was markedly higher in the intervention group than in the control group (64.95% vs 35.05%; χ Substantial improvements in triage guideline concordance were achieved and sustained without direct nursing education.
Sections du résumé
BACKGROUND
BACKGROUND
National Heart Lung and Blood Institute guidelines for the treatment of vaso-occlusive crisis among people with sickle cell disease in the emergency department recommend assigning an emergency severity index of 2 at triage. However, patients with sickle cell disease often do not receive guideline-concordant care at triage. To address this gap, a decision support tool was developed, in the form of a text banner on the triage page in the electronic health record system, visible to triage nurses.
METHODS
METHODS
A prospective quality improvement initiative was designed where the emergency severity index clinical decision support tool was deployed to a stratified random sample of emergency department triage nurses to receive the banner (n = 24) or not to receive the banner (n = 27), reminding them to assign the patient to emergency severity index category 2. The acceptability of the emergency severity index clinical decision support tool was evaluated with the Ottawa Acceptability of Decision Rules Instrument. Descriptive and bivariate (chi-square test) statistics were used to characterize the study's primary outcome, proportion of visits assigned an emergency severity index of 2 or higher. A generalized linear mixed model with clustering at the level of the triage nurse was performed to test the association between the banner intervention and triage practices.
RESULTS
RESULTS
A total of 384 ED visits were included for analysis. Before study initiation, the percentage of sickle cell disease patients' visits with the proper emergency severity index assignment at triage was 37.04%. After initiation, the proportion of sickle cell disease patients' visits with an emergency severity index of 2 or higher triaged by nurses in the intervention group was markedly higher in the intervention group than in the control group (64.95% vs 35.05%; χ
CONCLUSION
CONCLUSIONS
Substantial improvements in triage guideline concordance were achieved and sustained without direct nursing education.
Identifiants
pubmed: 34301422
pii: S0099-1767(21)00138-0
doi: 10.1016/j.jen.2021.05.007
pmc: PMC9924131
mid: NIHMS1866177
pii:
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Pagination
742-751.e1Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL142671
Pays : United States
Organisme : NIA NIH HHS
ID : T32 AG000247
Pays : United States
Organisme : NHLBI NIH HHS
ID : UG1 HL138645
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL133997
Pays : United States
Organisme : NIEHS NIH HHS
ID : R01 ES030717
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
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