1. Clinical decision support to Optimize Care of patients with Atrial Fibrillation or flutter in the Emergency department: protocol of a stepped-wedge cluster randomized pragmatic trial (O'CAFÉ trial)
- Author
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Vinson, David R, Rauchwerger, Adina S, Karadi, Chandu A, Shan, Judy, Warton, E Margaret, Zhang, Jennifer Y, Ballard, Dustin W, Mark, Dustin G, Hofmann, Erik R, Cotton, Dale M, Durant, Edward J, Lin, James S, Sax, Dana R, Poth, Luke S, Gamboa, Stephen H, Ghiya, Meena S, Kene, Mamata V, Ganapathy, Anuradha, Whiteley, Patrick M, Bouvet, Sean C, Babakhanian, Leon, Kwok, Edward W, Solomon, Matthew D, Go, Alan S, Reed, Mary E, and Kaiser Permanente CREST Network
- Subjects
Adult ,Patient admission ,Comparative Effectiveness Research ,Clinical Trials and Supportive Activities ,Clinical Sciences ,Decision Support Systems ,Atrial flutter ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Emergency Care ,Cardioversion ,7.3 Management and decision making ,Clinical ,Hospital ,Kaiser Permanente CREST Network ,Clinical Research ,General & Internal Medicine ,Atrial Fibrillation ,Pragmatic Clinical Trials as Topic ,Humans ,Randomized Controlled Trials as Topic ,Emergency Service ,Prevention ,Anticoagulants ,Health Services ,Atrial fibrillation ,Stroke ,Heart Disease ,Good Health and Well Being ,Atrial Flutter ,Cardiovascular System & Hematology ,Emergency medicine ,Management of diseases and conditions ,Randomized trial - Abstract
BackgroundManagement of adults with atrial fibrillation (AF) or atrial flutter in the emergency department (ED) includes rate reduction, cardioversion, and stroke prevention. Different approaches to these components of care may lead to variation in frequency of hospitalization and stroke prevention actions, with significant implications for patient experience, cost of care, and risk of complications. Standardization using evidence-based recommendations could reduce variation in management, preventable hospitalizations, and stroke risk.MethodsWe describe the rationale for our ED-based AF treatment recommendations. We also describe the development of an electronic clinical decision support system (CDSS) to deliver these recommendations to emergency physicians at the point of care. We implemented the CDSS at three pilot sites to assess feasibility and solicit user feedback. We will evaluate the impact of the CDSS on hospitalization and stroke prevention actions using a stepped-wedge cluster randomized pragmatic clinical trial across 13 community EDs in Northern California.DiscussionWe hypothesize that the CDSS intervention will reduce hospitalization of adults with isolated AF or atrial flutter presenting to the ED and increase anticoagulation prescription in eligible patients at the time of ED discharge and within 30days. If our hypotheses are confirmed, the treatment protocol and CDSS could be recommended to other EDs to improve management of adults with AF or atrial flutter.Trial registrationClinicalTrials.gov NCT05009225 .Registered on17 August 2021.
- Published
- 2023