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:
Vinson David R.ORCID, 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.,
Abstract
Abstract
Background
Management 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.
Methods
We 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.
Discussion
We 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 30 days. 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 registration
ClinicalTrials.gov NCT05009225. Registered on 17 August 2021.
Funder
The Permanente Medical Group Delivery Science and Applied Research Program
Publisher
Springer Science and Business Media LLC
Subject
Pharmacology (medical),Medicine (miscellaneous)
Reference134 articles.
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