Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol

IntroductionThe burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk populations and pre-emptive intervention using de-escalation techniques...

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Vydané v:BMJ open Ročník 14; číslo 2; s. e082834
Hlavní autori: Wong, Ambrose H, Nath, Bidisha, Shah, Dhruvil, Kumar, Anusha, Brinker, Morgan, Faustino, Isaac V, Boyce, Michael, Dziura, James D, Heckmann, Rebekah, Yonkers, Kimberly A, Bernstein, Steven L, Adapa, Karthik, Taylor, Richard Andrew, Ovchinnikova, Polina, McCall, Terika, Melnick, Edward R
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England British Medical Journal Publishing Group 19.02.2024
BMJ Publishing Group LTD
BMJ Publishing Group
Edícia:Protocol
Predmet:
ACCIDENT & EMERGENCY MEDICINE
Adult
Best practice
Clinical decision making
Clinical Trial
Community
Decision Support Systems, Clinical
Electronic health records
Emergency medical care
Emergency Medicine
Emergency Service, Hospital
Health informatics
Humans
Informatics
Information technology
Informed Consent
Intervention
MENTAL HEALTH
Patients
Peer tutoring
Physical restraints
PSYCHIATRY
Randomized Controlled Trials as Topic
Research Design
Risk assessment
Usability
United States > US
MENTAL HEALTH
Clinical Trial
PSYCHIATRY
Information technology
ACCIDENT & EMERGENCY MEDICINE
Health informatics
ISSN:2044-6055, 2044-6055
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Popis
Shrnutí:IntroductionThe burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk populations and pre-emptive intervention using de-escalation techniques to prevent agitation. Time pressure, fluctuating work demands, and other systems-related factors pose challenges to efficient decision-making and adoption of best practice recommendations during an unfolding behavioural crisis. As such, we propose to design, develop and evaluate a computerised clinical decision support (CDS) system, Early Detection and Treatment to Reduce Events with Agitation Tool (ED-TREAT). We aim to identify patients at risk of agitation and guide ED clinicians through appropriate risk assessment and timely interventions to prevent agitation with a goal of minimising restraint use and improving patient experience and outcomes.Methods and analysisThis study describes the formative evaluation of the health record embedded CDS tool. Under aim 1, the study will collect qualitative data to design and develop ED-TREAT using a contextual design approach and an iterative user-centred design process. Participants will include potential CDS users, that is, ED physicians, nurses, technicians, as well as patients with lived experience of restraint use for behavioural crisis management during an ED visit. We will use purposive sampling to ensure the full spectrum of perspectives until we reach thematic saturation. Next, under aim 2, the study will conduct a pilot, randomised controlled trial of ED-TREAT at two adult ED sites in a regional health system in the Northeast USA to evaluate the feasibility, fidelity and bedside acceptability of ED-TREAT. We aim to recruit a total of at least 26 eligible subjects under the pilot trial.Ethics and disseminationEthical approval by the Yale University Human Investigation Committee was obtained in 2021 (HIC# 2000030893 and 2000030906). All participants will provide informed verbal consent prior to being enrolled in the study. Results will be disseminated through publications in open-access, peer-reviewed journals, via scientific presentations or through direct email notifications.Trial registration numberNCT04959279; Pre-results.
Bibliografia:Protocol
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2023-082834