Tailored Dissemination and Implementation of Emergency Care Clinical Decision Support to Improve Emergency Department Disposition
MPIs: Alan Storrow, MD; Dandan Liu, PhD; Sunil Kripalani, MD, MSc
Supported by: NIH/NHLBI 1R01HL157596
Heart failure is one of the most common reasons for hospital admission. STRATIFY is a validated model that identifies which patients presenting to the Emergency Department with heart failure exacerbations are at low risk of adverse outcomes and could potentially be discharged home. In this study, we developed a new clinical decision support tool and multicomponent implementation strategy to incorporate STRATIFY into clinical workflows in the Emergency Department. In a multicenter trial, we are evaluating the effect of implementing the new STRATIFY tool on admission/discharge disposition for heart failure patients, as well as studying variations in implementation across sites.
PREVENTABLE (PRagmatic EValuation of evENTs And Benefits of Lipid-lowering in OldER Adults)
MPI: Christianne Roumie
Supported by: U19 AG065188 from the National Institute on Aging (NIA) with contribution from the National Heart, Lung, and Blood Institute (NHLBI). (not a comprehensive list)
There is an urgent need for evidence to guide the clinical care of older adults due to demographic shifts including longer life expectancy and a doubling of the older adult population in recent decades. Unfortunately, clinical research has often excluded individuals over the age of 75 due to a higher prevalence of comorbidity and frailty. There is equipoise regarding the usefulness of statins for primary CVD prevention in adults over age 75, especially in the setting of multiple chronic conditions advanced age or frailty. The ability of statins to prevent new dementia or persisting disability is unknown. There may be subgroups of older adults without CVD or dementia who stand to benefit from statins and others who do not. Such a trial will advance evidence-based care – replacing current opinion-driven practice. Using a placebo-controlled pragmatic trial design across a network of health care systems, we will evaluate the effects and benefits of a moderate intensity statin on important health outcomes for older adults.
Nursing Practice Transformation Initiative at Vanderbilt University Medical Center
PI: Sandra Simmons PhD
Supported by: the Tennessee Department of Health Healthcare Resiliency Program
Nationally and locally within the state of Tennessee, hospitals have continued to face a shortage of registered nurses, which was further exacerbated by the pandemic. Nurse staffing challenges continue for many hospitals in the absence of objective ways to evaluate alternative nurse staffing models. This quality improvement project applies discrete event simulation modeling to safely determine optimal nurse staffing allocations for both licensed nurses and unlicensed support staff for different types of hospital units based on clinical workflows and inpatient care needs. This approach provides a safe way to evaluate the potential impact of alternative nurse staffing allocations prior to implementation.
Inpatient Penicillin Allergy Delabeling
MPIs: Cosby Stone
Supported by: AHRQ R01HS030234
At Vanderbilt’s Learning Healthcare System, we’ve studied two inpatient penicillin allergy delabeling models using risk-stratified direct challenges: “champion driven” and “decentralized.” The champion-driven model, launched in 2019, involves a dedicated team member conducting evaluations daily, as seen in our ICU pilot. The decentralized model, tested in the PROPEL trial starting in 2020, relies on healthcare workers performing evaluations as able, supported by EHR tools and education. Both models benefit from hospital-approved protocols, strong documentation, and patient education. In our case, both versions of the workflow are ongoing and have operated on a daily basis for years in the inpatient setting, demonstrating sustainability and complementary effort over time. Rigorous evaluation revealed improved antibiotic stewardship, reduced allergy labeling among readmitted patients, low relabeling rates, and cost savings from avoiding expensive antibiotics and desensitizations. Delabeling in the hospital setting is also rewarding and appreciated by patients and providers, as it removes barriers to optimal antibiotic care when it’s most needed.
Care, Review, Assessment and Feedback Tool in Acute Respiratory Infections (CRAFT-IAR)
MPIs: Dr. Michael Ward and Dr. Milner Staub
Supported by: NIH grant R01AI187244
Researchers at Vanderbilt University Medical Center received a five-year, $4.1 million NIH grant to study antibiotic prescribing and antimicrobial stewardship in unplanned care settings like ERs and walk-in clinics. Led by Drs. Michael Ward and Milner Staub, the study will test an enhanced intervention called CRAFT-IAR, adapted from the original CRAFT tool, to reduce unnecessary antibiotic use for upper respiratory infections (URIs). The randomized trial will span up to 31 clinics, which see around 90,000 URI visits annually. The intervention includes education, decision support, and clinician feedback. Researchers aim to cut inappropriate prescriptions—currently estimated at 23%–51%—by at least 10%, helping combat antimicrobial resistance.