ISRCTN - ISRCTN72253051: An evaluation of the Junior Doctors' Dashboard

Plain English Summary

Background and study aims:
Research has shown how preventable medication errors have contributed to deaths within the healthcare system. Computerised systems have been proposed and developed to help reduce these errors these can be called clinical decision support systems. Even though electronic prescribing and clinical decision support systems are widely used in England now there is still a need to monitor the use of these systems to aid successful implementation and adoption. Performance measurement and feedback are key elements in identifying problems and helping individuals improve their performance. Providing feedback to junior doctors can offer insight into their clinical practice and prescribing behaviours, giving them the opportunity to learn from potential near misses that are indicated by warnings and alerts generated by a clinical decision support system. Making doctors aware of how they compare with safe levels of prescribing competence can be the catalyst needed to modify their behaviour.

This study will recruit junior doctors within the University Hospitals Birmingham NHS Foundation Trust who use the Prescribing, Information and Communication System on the wards in the trust. The doctors will be randomly allocated to the experiment or control group. The intervention is the Junior Doctors' Dashboard (JDD); a web enabled application that displays graphical information in the form of dials portraying a doctor's prescribing activity for the past 4 months. The dials show whether doctors ignore or acknowledge the warnings, alarms and alerts generated by the system when they prescribe or when they receive laboratory results. These could be warnings for entering excessive doses or for potentially serious drug interactions, alarms and alerts for laboratory results displayed on the system.

The main study aims are to determine:
1. If personalised electronic feedback can change the way junior doctors use the electronic Prescribing Information and Communication System.
2. If the JDD can improve professional performance and enhance patient safety practice.
3. The views of junior doctors to feedback given via a clinical dashboard (JDD) and automated email alerts.
4. What importance junior doctors place on alerts and warnings generated by such systems in healthcare and specifically within their work setting.
5. The characteristics/components of the feedback that influenced the junior doctors behaviour.

Who can participate?
Doctors working in the University Hospitals Birmingham NHS Foundation Trust below specialist trainee level 3 (within about four years of graduation and equivalent to junior residents) who have used PICS for four months before the trial, and who would be using the system during the trial period.

What does the study involve?
The eligible doctors will be randomly allocated to the intervention or control group. In addition to having access to the JDD, the intervention group will also receive weekly emails on their prescribing performance. These emails will have a link to the JDD and it is envisaged that accessing the JDD will take 3-4 minutes, once a week.
The control group will not receive this specific feedback and will not have access to the JDD. A random sample of participants from both groups will be invited to take part in a one-to-one interview, with others invited to take part in focus group interviews.

What are the possible benefits and risks of participating?
This research may provide some individual benefits in the longer term including improving the prescribing skills of junior doctors. Additional benefits include the potential reduction of prescription errors, improved professional performance and increased patient safety practice.
There are no risks to participants identified for this study, although the time involved in participating in the interview could be a burden to some participants.

Where is the study run from?
Queen Elizabeth Hospital Birmingham, part of the University Hospitals Birmingham NHS Foundation Trust

When is study starting and how long is it expected to run for?
The study ran for 6 months from 1st April to the 30th October 2011.

Who is funding the study?
The National Institute for Health Research through its Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Birmingham & Black Country.

Who is the main contact?
Dr Jamie Coleman
j.j.coleman@bham.ac.uk

Trial website

Contact information

Type

Scientific

Primary contact

Dr Jamie Coleman

ORCID ID

Contact details

Clinical and Experimental Medicine
The Medical School
University of Birmingham
Edgbaston
Birmingham
B15 2TT
United Kingdom
j.j.coleman@bham.ac.uk

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

11/EM/0007

Study information

Scientific title

Effects of computerised feedback intervention on performance: An evaluation of the JDD (Junior Doctors' Dashboard

Acronym

Study hypothesis

Junior doctors will change their prescribing habits when the dashboard shows that they are performing poorly compared to their cohort.

Ethics approval

East Midlands - Nottingham Research Ethics Committee, 21 February 2011 ref: 11/EM/0007

Study design

A single-site parallel group randomised controlled trial with individual and focus group interviews to evaluate the impact of a web-based feedback tool on the prescribing behaviour of junior doctors.

Primary study design

Interventional

Secondary study design

Randomised controlled trial

Trial setting

Hospitals

Trial type

Quality of life

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet

Condition

This study evaluates the impact of a feedback tool which measures performance and evaluates the effect to prescribing behaviour when performance is fedback to junior doctors prescribing using the Prescribing Information and Communication System in a university teaching hospital.

Intervention

The intervention for the experiment group is access to the Junior Doctors Dashboard (JDD). The JDD is an automated computerised performance feedback tool with 8 dials. Six dials show prescription warning information and 2 dials show laboratory alerting and acceptance rates. For 4 months from the beginning of April 2011, we sent each participant in the intervention group weekly e-mails with a link to his or her unique individual dashboard. Each individual dashboard compared the doctor's performance with the rest of the intervention group.

Intervention type

Other

Phase

Not Applicable

Drug names

Primary outcome measure

1. A difference in responses (on the dials identified in the primary outcome)to warnings, alarms and alerts between the months before and the months after the intervention
2. A difference in performance between participants receiving feedback and the control group
3. Differences between the following dials:
3.1. Disallow warnings for excessive dosing
3.2. Password warnings for excessive dosing and interactions
3.3. Laboratory alarms and alerts.

Secondary outcome measures

The differences between the following dials:
1. Disallow warnings for contraindications
2. Allergies and interactions / password warnings for contraindications and allergies

Overall trial start date

01/04/2011

Overall trial end date

31/10/2011

Reason abandoned (if study stopped)

Eligibility

Participant inclusion criteria

Any doctor within the Trust who is below ST3 level (i.e. below specialty / specialist registrar level) and not within the exclusion criteria who had used PICS for four months preceding the trial, and who
would be using the system during the trial period.

Participant type

Patient

Age group

Adult

Gender

Both

Target number of participants

143

Participant exclusion criteria

1. Doctors who are not actively using the PICS system (those who have issued fewer than 10 prescriptions in the baseline period).
2. Doctors who had only recently joined the hospital and for whom no baseline data were available.

Recruitment start date

01/04/2011

Recruitment end date

31/10/2011

Locations

Countries of recruitment

United Kingdom

Trial participating centre

Clinical and Experimental Medicine
Birmingham
B15 2TT
United Kingdom

Sponsor information

Organisation

University Hospitals Birmingham NHS Foundation Trust (UK)

Sponsor details

Birmingham Clinical Research Office
Queen Elizabeth Hospital Birmingham
Mindelsohn Way
Edgbaston
Birmingham
B15 2WB
United Kingdom

Sponsor type

Hospital/treatment centre

Website

http://www.uhb.nhs.uk/research

Funders

Funder type

Government

Funder name

National Institute for Health Research - Birmingham and Black Country CLAHRC (UK)

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data