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Open Access 01-12-2023 | Stroke | Study protocol

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)

Authors: David R. Vinson, Adina S. Rauchwerger, Chandu A. Karadi, Judy Shan, E. Margaret Warton, Jennifer Y. Zhang, Dustin W. Ballard, Dustin G. Mark, Erik R. Hofmann, Dale M. Cotton, Edward J. Durant, James S. Lin, Dana R. Sax, Luke S. Poth, Stephen H. Gamboa, Meena S. Ghiya, Mamata V. Kene, Anuradha Ganapathy, Patrick M. Whiteley, Sean C. Bouvet, Leon Babakhanian, Edward W. Kwok, Matthew D. Solomon, Alan S. Go, Mary E. Reed, on behalf of the Kaiser Permanente CREST Network

Published in: Trials | Issue 1/2023

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.

Available only for authorised users

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Title: 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)
Authors: David R. Vinson
Adina S. Rauchwerger
Chandu A. Karadi
Judy Shan
E. Margaret Warton
Jennifer Y. Zhang
Dustin W. Ballard
Dustin G. Mark
Erik R. Hofmann
Dale M. Cotton
Edward J. Durant
James S. Lin
Dana R. Sax
Luke S. Poth
Stephen H. Gamboa
Meena S. Ghiya
Mamata V. Kene
Anuradha Ganapathy
Patrick M. Whiteley
Sean C. Bouvet
Leon Babakhanian
Edward W. Kwok
Matthew D. Solomon
Alan S. Go
Mary E. Reed
on behalf of the Kaiser Permanente CREST Network
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Stroke
Emergency Medicine
Anticoagulant
Care
Atrial Fibrillation
Atrial Flutter
Published in: Trials / Issue 1/2023
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/s13063-023-07230-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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)

Abstract

Background

Methods

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

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