The goal of this experimental study is to learn whether different types of Electronic Health Record (EHR) alerts that direct clinicians to reference clinical guidelines embedded in the increase the use of these guidelines and the delivery of evidence-based care in children presenting to the hospital with bronchiolitis. The main questions it aims to answer are:
* Do EHR-alerts increase clinicians' us of evidence-based EHR-integrated Clinical Decision Support (CDS) guidelines for the care of bronchiolitis and * Is the use of EHR-integrated CDS-guidelines for the care of bronchiolitis associated with deceases in low-value use of High Flow Nasal Cannula (HFNC) and improvement in other aspects of high-value care for this disease
Patients will be randomized on the encounter-level to have the patient's treating providers receive no EHR-alert or one of two types of EHR-alert (non-interruptive or interruptive) reminding the provider that the EHR-integrated CDS guideline is available for the care or bronchiolitis. Researchers will compare the rate of use of EHR-integrated CDS guidelines in patients whose clinicians did not receive any EHR-alerts, to those whose clinicians received a non-interruptive alert and to those whose clinicians received an interruptive Best Practice Advisory (BPA). In addition, the study will evaluate whether the utilization of the EHR-integrated CDS guideline in a given encounter was associated with less low-value HFNC use, and differences in other elements of low-value care for bronchiolitis.
Patients in all groups will continue to receive standard hospital care for bronchiolitis as determined by the patient's treating clinicians.
Children <=24 months of age presenting to the emergency room and/or hospitalized (under observation or inpatient status) with EHR-indicators of bronchiolitis at one of three study sites. EHR-indicators of bronchiolitis include the use of bronchiolitis-specific order sets, or specific combinations of ED chief complaint, infection or isolation status, and the receipt of disease-relevant therapies (such as oxygen supplementation)
Current encounter is birth-encounter
Currently hospitalized in an ICU
Hospitalized with length of stay >14 days
Parallel
Non-interruptive
Other interventionThe non-interruptive EHR alert appears as a visual cue but does not require clinicians to alter workflows. The alert directs clinicians to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.
Interruptive
Other interventionThe interruptive EHR alert requires clinicians to interact with the alert to continue the workflow. The alert directs clinicians to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.
Proportion of encounters provider utilizes EHR-integrated clinical decision support tool
Use of the EHR-integrated Clinical Decision Support Guideline. The proportion of encounters in which a provider utilizes the EHR-integrated clinical decision support tool for the care of bronchiolitis during a given encounter.
Proportion of encounters providers utilize the EHR-integrated clinical decision support tool for the care of bronchiolitis
Multiple Use of the EHR-integrated clinical decision support guideline. The proportion of encounters in which providers utilize the EHR-integrated clinical decision support tool for the care of bronchiolitis multiple times (2 or more times) during a given encounter.
Proportion of encounters a provider enters orders via the EHR-integrated clinical decision support tool
Order entry via the EHR-integrated clinical decision support guideline. The proportion of encounters a provider enters orders via the EHR-integrated clinical decision support tool for the care of bronchiolitis during a given encounter.
Proportion of patients who receive any subtherapeutic high flow nasal cannula (HFNC) treatment
Post-randomization - Individual Clinical Outcome 1 - Subtherapeutic HFNC. The proportion of patients who receive any subtherapeutic high flow nasal cannula (HFNC) treatment, defined as HFNC with a flow rate \<1L/kg/min for patients \<15kg or \<15L/min for patients \>15kg. Comparator groups will be those in whom providers utilized the EHR-integrated clinical decision support guideline vs. those in whom the guideline was not accessed.
The average number of hours during which a patient received subtherapeutic high flow nasal cannula (HFNC) treatment
Post Randomization - Individual Clinical Outcome 2 - Hours spent on subtherapeutic HFNC. The average number of hours during which a patient received subtherapeutic high flow nasal cannula (HFNC) treatment, defined as HFNC with a flow rate \<1L/kg/min for patients \<15kg or \<15L/min for patients \>15kg. Comparator groups will be those in whom providers utilized the EHR-integrated clinical decision support guideline vs. those in whom the guideline was not accessed.
Proportion of patients who receive any treatment with high flow nasal cannula
Post Randomization - Systems Level Outcome 1 - Proportion Receiving any HFNC. The proportion of patients who receive any treatment with high flow nasal cannula. Comparator groups will be those in whom providers utilized the EHR-integrated clinical decision support guideline vs. those in whom the guideline was not accessed.
The total time (in hours) during which patients received any treatment with high flow nasal cannula
Post Randomization - Systems Level Outcome 2 - Total time on HFNC. The total time (in hours) during which patients received any treatment with high flow nasal cannula. Comparator groups will be those in whom providers utilized the EHR-integrated clinical decision support guideline vs. those in whom the guideline was not accessed.
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