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Table 4 Adaptions to Support-ED Tool and Associated Rationale

From: Design and implementation of a clinical decision support tool for primary palliative Care for Emergency Medicine (PRIM-ER)

Adaptation

Rationale

Alert #3 fires only for patients with an ESI of 1, 2 or 3

Resulted from provider feedback regarding the lack of utility of this firing on lower acuity patients.

If a palliative care consultation was already placed, Alert #3 does not fire

Amended to reduce the redundancy of orders.

Update all three alerts to fire for all the providers on the ED care team

Goal was to notify each of the providers on the ED care team instead of for example, only the attending provider.

Discontinue all three alerts from firing for providers that are not part of the ED care team (e.g. consultants)

Amended to target the right provider.

Update all three alerts to fire only once for each ED provider

Amended to reduce the redundancy of alert firing.

Firing of Alert #1 and Alert #3 changed from T + 60 min to T + 90 min after ED arrival

Based on provider feedback recommending firing later to allow sufficient time for patient evaluation and analysis of lab results.

Removal of “previous discharge disposition to nursing home” and “GFR < 15 ml/min/m2” from criteria for Alert #3

Based on dashboard feedback, these two criteria led to the most frequent firing and thus, these two were removed to increase alert specificity.

Suspension of Alert #3

Based on negative comments and over-firing, the decision was made to suspend this alert.