Clinical Decision Support Optimizing Necrotizing Enterocolitis Prevention Implementation in Neonatal Intensive Care Unit (Arizona)

Project Details - Ongoing

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Summary:

Necrotizing enterocolitis (NEC) is a serious life-threatening complication of fragile premature infants, yet adoption of prevention and early recognition practices, such as use of human milk, adoption of standardized feeding protocols, and transfusion and antibiotics management, differs widely. Thus, there is a need to improve the application of evidence-based practices for prevention and early recognition of NEC among premature infants. To address this need, the project team has previously developed and validated a risk decision rule to accurately discriminate NEC. This followup project will integrate clinical decision support (CDS) into providers’ workflow in neonatal intensive care units (NICUs) to deliver evidence-based guidelines for early recognition and prevention of necrotizing enterocolitis in an intervention called “NEC-Zero.”

Informed by the Translating Research Into Practice (TRIP) framework for implementation science, the project team will integrate NEC-Zero to fit clinician workflow and optimize usability in two NICUs, using an interrupted time series design and will test its impact on NEC disease, neonate nutrition, and parental satisfaction.

The specific aims of the project are as follows:

  • Describe clinician workflow derived through workflow maps constructed from interviews with local clinicians and then integrate NEC-Zero into CDS in the form of standard order sets, alerts, reminders, and trend data 
  • Optimize NEC-Zero usability using a simulated NEC scenario and iterative evaluation 
  • Compare NEC disease (incidence, surgical NEC, and mortality), neonate nutrition (feeding indicators), and parent satisfaction pre- and post-intervention and describe the relationship between post-NEC-Zero clinician CDS outcomes (adherence scores, use response rates, satisfaction, and perception of unintended consequences of CDS) and NEC disease outcomes.
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