142nd APHA Annual Meeting and Exposition

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308775
Implementation of the PECARN traumatic brain injury prediction rules using electronic health record-based clinical decision support: An interrupted time series trial

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 3:30 PM - 3:50 PM

Peter Dayan, MD, MSc , Pediatric Emergency Division, The Children's Hospital of New York-Presbyterian, New York, NY
Eric Tham, MD, MPH , Pediatric Emergency Care Applied Research Network (PECARN)
Sara Deakyne, MPH
Marguerite Swietlik, MSN, CRNP , Pediatric Emergency Care Applied Research Network (PECARN)
Robert Grundmeier, MD , Pediatric Emergency Care Applied Research Network (PECARN)
Jeff Hoffman, MD , Pediatric Emergency Care Applied Research Network (PECARN)
Leah Tzimenatos, MD , Pediatric Emergency Care Applied Research Network (PECARN)
Evaline Alessandrini, MD, MSCE
Lalit Bajaj, MD, MPH
Larry Cook, MStat, PhD , Intermountain Injury Control Research Center, University of Utah, Salt Lake City, UT
Lise Nigrovic, MD, MPH
Suzanne Bakken, RN, PhD
Barbara Sheehan, PhD, PNP , Pediatric Emergency Care Applied Research Network (PECARN)
Charlie Casper, PhD , Pediatric Emergency Care Applied Research Network (PECARN)
Jeff Yearly, BA , Pediatric Emergency Care Applied Research Network (PECARN)
Nathan Kuppermann, MD, MPH , Department of Emergency Medicine, UC Davis School of Medicine, Davis, CA
Howard Goldberg, MD , Partners HealthCare System
Marilyn Paterno, MBI , Partners HealthCare System
Molly Schaeffer, MS , Partners HealthCare System
Deepika Pabbathi, MSc(IS) , Partners HealthCare System
Roberto Rocha, MD, PhD , Partners HealthCare System
Richard Boyer, MSCS , Partners HealthCare System
Yelena Kleyner , Partners HealthCare System
Dustin Ballard, MD, MBE , Department of Emergency Medicine, Kaiser Permanente Medical Center, San Rafael, San Rafael, CA
Robert Norris, MD , Kaiser Permanente Clinical Research in Emergency Services & Treatments (CREST) Network
Steve Offerman, MD , Kaiser Permanente Clinical Research in Emergency Services & Treatments (CREST) Network
Dustin Mark, MD , Department of Emergency Medicine, Kaiser Permanente Medical Center, Oakland, Oakland, CA
David Vinson, MD , Department of Emergency Medicine, Kaiser Permanente Medical Center, Sacramento, Sacramento, CA
Mamata Kene, MD , Kaiser Permanente Clinical Research in Emergency Services & Treatments (CREST) Network
Uli Chettipally, MD, MPH , Kaiser Permanente Clinical Research in Emergency Services & Treatments (CREST) Network
Audio (mp3) recording Recorded Presentation (mp4)
Objective: To assess whether implementing two age-specific Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) clinical prediction rules via clinical decision support (CDS) integrated into the electronic health record (EHR) decreases the number of (unnecessary) cranial computed tomography (CT) scans obtained by clinicians in the emergency department (ED) in children with minor blunt head trauma (BHT) at very low risk of clinically-important TBIs.

Methods: Multicenter interrupted time-series trial with controls. We developed centrally and implemented across sites: a) a chief complaint-based process to trigger data collection for appropriate patients in the EHR; b) an EHR BHT data collection template that captures patient-specific risk factors necessary to assess the risk of clinically-important TBIs; c) CDS provided by either a platform-independent CDS cloud service or locally-provided CDS (i.e. using the local EHR’s CDS rules engine); and d) a data transfer process to extract data from the EHR and upload it to the PECARN data center. The CDS provides clinicians patient-specific CDS in real-time, with recommendations regarding CT use. We will measure change in CT use and patient outcomes before and after CDS within and across sites.

Results: We have successfully implemented all aspects of the trial, including implementation of the CDS cloud-service at two sites.  Data collection is ongoing, with more than 25,000 patients having data successfully transferred to the data center.

Conclusions/Implications: BHT data collection in the EHR, resulting in the provision of patient-specific CDS, can be implemented across sites using a centralized development process with local implementation.

Learning Areas:

Clinical medicine applied in public health
Communication and informatics
Provision of health care to the public

Learning Objectives:
Describe how the electronic health record can be used to aid in decision support for children with minor blunt head trauma in the emergency department. Define knowledge translation and its relationship to research.

Keyword(s): Decision-Making, Traumatic Brain Injury

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a statistician with the PECARN network for eight years. I have been chair of the data committee for five years and a member of the section for 15 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4332.0: Injury and emergency health data issues: Injury data, electronic health records, and external cause of injury