CDS + HHFNC Weaning for Bronchiolitis
(REST EEC Trial)
Recruiting in Palo Alto (17 mi)
Age: < 18
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Pittsburgh
Disqualifiers: Immunocompromised, Immunosuppressed, Chronic lung disease, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This project aims to answer the essential questions about the management of acute, pediatric respiratory illness, accelerate recovery from these all-too-common diseases, curb unnecessary costs of care, and demonstrate UPMC Children's Hospital of Pittsburgh's capabilities as the premier, world-class leader in the arena of pediatric learning healthcare systems. REST EEC will focus on the question of whether clinical decision support (CDS) facilitates the standardization of the initiation and weaning of heated high flow nasal cannula (HHFNC) for bronchiolitis.REST EEC will focus on whether the application of CDS improves adherence to a standardized guideline and leads to improved patient-centered outcomes.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment Clinical Decision Support (CDS) for bronchiolitis?
Clinical Decision Support (CDS) systems have been shown to improve decision-making in various medical conditions, such as reducing unnecessary antibiotic prescriptions for respiratory infections and improving care efficiency in pulmonary embolism cases. This suggests that CDS could potentially enhance treatment strategies for bronchiolitis as well.
12345Is the CDS system generally safe for use in humans?
The research indicates that Clinical Decision Support (CDS) systems are designed to improve patient safety by minimizing medication errors through alerts about drug interactions and allergies. However, there is a high rate of alert overrides by users, suggesting that the system's alerts may not always be specific or useful, which could impact safety.
678910How is the CDS + HHFNC Weaning treatment for bronchiolitis different from other treatments?
The CDS + HHFNC Weaning treatment for bronchiolitis is unique because it involves a structured approach to gradually reduce the use of high-flow nasal cannula (HFNC) therapy, which is a method of providing oxygen through a tube in the nose. This approach aims to optimize the duration and effectiveness of HFNC therapy, which is not standardized in current treatments.
1112131415Eligibility Criteria
This trial is for children under 2 years old with bronchiolitis and a work of breathing (WOB) score greater than 2. It's not suitable for kids with congenital heart disease affecting their breathing, those who have weakened immune systems, or chronic lung conditions.Inclusion Criteria
My child is under 2 years old with a severe breathing difficulty score over 2.
Exclusion Criteria
I have a long-term lung condition.
I was born with a heart condition that affects my breathing and heart function.
My immune system is weak.
+1 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive heated high flow nasal cannula (HHFNC) with or without clinical decision support (CDS) for bronchiolitis
Up to 30 days
Follow-up
Participants are monitored for safety and effectiveness after treatment, including PICU and hospital length of stay, mortality, and respiratory support free days
Up to 90 days
Participant Groups
The study tests if using Clinical Decision Support (CDS) can help doctors better follow guidelines when starting and adjusting heated high flow nasal cannula (HHFNC) therapy in young patients with bronchiolitis to improve recovery outcomes.
2Treatment groups
Experimental Treatment
Active Control
Group I: HHFNC + Clinical decision SupportExperimental Treatment2 Interventions
Standardized HHFNC weaning coupled with clinical decision support consisting of electronic record embedded reminders to the clinical team to wean HHFNC
Group II: HHFNC WeaningActive Control2 Interventions
Team does not receive clinical decision support reminders to wean the HHFNC
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
UPMC Children's Hospital of PittsburghPittsburgh, PA
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Who Is Running the Clinical Trial?
University of PittsburghLead Sponsor
Christopher HorvatLead Sponsor
Beckwith FoundationCollaborator
References
Clinical decision support systems for chronic obstructive pulmonary disease (COPD) in hospitals: A systematic review. [2023]To synthesise the literature on clinical decision support (CDS) systems for chronic obstructive pulmonary disease (COPD). We aimed to (1) describe existing COPD CDS systems that have been designed, developed or are being used in practice, (2) describe the impact of COPD CDS systems on outcomes and (3) identify barriers and facilitators to implementation of COPD CDS systems.
A hybrid hierarchical decision support system for cardiac surgical intensive care patients. Part I: Physiological modelling and decision support system design. [2015]To develop a clinical decision support system (CDSS) that models the different levels of the clinician's decision-making strategies when controlling post cardiac surgery patients weaned from cardio pulmonary bypass.
Impact of Clinical Decision Support on Antibiotic Prescribing for Acute Respiratory Infections: a Cluster Randomized Implementation Trial. [2021]Clinical decision support (CDS) is a promising tool for reducing antibiotic prescribing for acute respiratory infections (ARIs).
Clinical Decision Support to Reduce Opioid Prescriptions for Dental Extractions using SMART on FHIR: Implementation Report. [2023]Clinical decision support (CDS) has the potential to improve clinical decision-making consistent with evidence-based care. CDS can be designed to save health care providers time and help them provide safe and personalized analgesic prescribing.
Human-centred design processes for clinical decision support: A pulmonary embolism case study. [2021]Clinical Decision Support Systems (CDSS) can make patient care more efficient, cost-effective, and guideline-concordant. Many are created by clinicians who understand the challenges, but may publish concepts before considering subtle but important design details. Human-Centred Design (HCD) approaches provide necessary methods ensuring solid CDSS design. This article highlights HCD approaches in a pulmonary embolism CDSS case study context.
Impact of an electronic health record alert on inappropriate prescribing of high-risk medications to patients with concurrent "do not give" orders. [2022]To evaluate the effectiveness of clinical decision support (CDS) alerts tied to high-risk medications at a Michigan health system by determining the true prescriber action rate in response to select "do not give" (DNG) alerts.
Characteristics of clinical decision support alert overrides in an electronic prescribing system at a tertiary care paediatric hospital. [2022]CONTEXT Electronic prescribing (EP) systems are advocated as a solution to minimise medication errors. Benefits in patient safety are often as a result of some clinical decision support (CDS) within the system. OBJECTIVE To study the characteristics of the CDS alerts generated within a commercially available EP system in use at a tertiary care paediatric hospital in the UK. METHODS Retrospective review and characterisation of CDS alerts recorded in the EP system over 1 year. RESULTS A total of 16 182 conflict alerts were recorded when ordering 26 836 items, of which 3507 (13 alerts per 100 prescription orders (95% confidence interval, 12.8 to 13.6)) were visible to the user. Eighty nine percent (3119/3507) of all visible alerts were overridden by the user at point of prescribing. Drug-allergy conflict alerts were the most accepted, and exact drug duplication alerts the least. CONCLUSION We found a high incidence of alert override, which is undesirable but consistent with that reported in the literature. The results suggest that the underlying algorithms for alert generation in many EP systems are not specific and need to be reviewed.
Development of a SNOMED CT based national medication decision support system. [2013]Physicians often lack the time to familiarize themselves with the details of particular allergies or other drug restrictions. Clinical Decision Support (CDS), based on a structured terminology as SNOMED CT (SCT), can help physicians get an overview, by automatically alerting allergy, interactions and other important information. The centralized CDS platform based on SCT, controls Allergy, Interactions, Risk Situation Drugs and Max Dose restrictions by the help of databases developed for these specific purposes. The CDS will respond to automatic web service requests from the hospital or GP electronic medication system (EMS) during prescription, and return alerts and information. The CDS also contains a Physicians Preference Database where the physicians individually can set which kind of alerts they want to see. The result is clinically useful information physicians can use as a base for a more effective and safer treatment, without developing alert fatigue.
Clinical decision support alert appropriateness: a review and proposal for improvement. [2022]Many healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes.
Clinical decision support malfunctions related to medication routes: a case series. [2023]To identify common medication route-related causes of clinical decision support (CDS) malfunctions and best practices for avoiding them.
Is implementation of a hospital pathway for high-flow nasal cannula initiation and weaning associated with reduced high-flow duration in bronchiolitis? [2023]High-flow nasal cannula (HFNC) therapy is widely used for children with bronchiolitis, but its optimal role remains uncertain. Our institution created and later revised a clinical pathway guiding HFNC initiation and weaning.
A randomised trial of high-flow nasal cannula in infants with moderate bronchiolitis. [2022]The objective was to determine whether high-flow nasal cannula (HFNC), a promising respiratory support in infant bronchiolitis, could reduce the proportion of treatment failure requiring escalation of care.
Implementation of a High-Flow Nasal Cannula Management Protocol in the Pediatric ICU. [2023]High-flow nasal cannula (HFNC) therapy is a respiratory modality that has been adopted to support pediatric patients with bronchiolitis. There is no standardized protocol for initiation, escalation, or weaning of HFNC in the pediatric ICU. The aim of this respiratory therapist (RT)-driven quality improvement management protocol was to decrease duration of HFNC.
Incorporating a Nebulizer System Into High-Flow Nasal Cannula Improves Comfort in Infants With Bronchiolitis. [2018]High-flow nasal cannula (HFNC) is increasingly used to provide respiratory support in infants with bronchiolitis. The delivery of aerosol therapy through a jet nebulizer is widely indicated despite its controversial efficacy and poor tolerability.
High-flow nasal cannula oxygen therapy for infants with bronchiolitis: pilot study. [2022]To obtain data on the safety and clinical impact of managing infants with bronchiolitis on the ward with high-flow nasal cannula (HFNC) treatment.