Nudging Provider Adoption of Clinical Decision Support: Implementation of an EHR-Agnostic Pulmonary Embolism Risk Prediction Tool

The purpose of this study is to examine the impact of the nudge implementation strategy (CDS tool + Nudge) on adoption of guideline-concordant CT ordering for pulmonary embolism (PE) in 10 EDs. The study will be a 33-month, rigorous, pragmatic, cluster-randomized, stepped wedge trial across 3 health systems and 10 EDs after collecting pre-implementation baseline data. The aim is to to demonstrate technological feasibility as well as examine efficacy of the nudges on adoption. The secondary objective is to decrease CT-ordering when it is not indicated.

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Key information

Conditions

Pulmonary Embolism Cardiovascular Diseases Embolism Embolism and Thrombosis Lung Diseases Respiratory Tract Diseases Vascular Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Northwell Health - Feinstein Institute for Medical Research, Manhasset, New York, United States

About this study

Part 1 of the study included the collection of data. During the pre-implementation period each sites electronic health record (EHR) and baseline data was collected for 12 months. In Part 2, the study will examine the impact of the nudge implementation strategy (CDS tool + Nudge) on adoption of guideline-concordant CT ordering for PE in 10 EDs. Adoption outcomes data will be collected through EHR reporting systems.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

18 years of older
A provider (MD, NP, PA) ordering CTs for evaluation of PE in adult patients present at study site Emergency Department (i.e., Northwell Health - Feinstein Institute for Medical Research, Baylor College of Medicine and NYU Langone Health).

Exclusion criteria

A provider not present at the specified study sites.

Treatment and study plan

Clinical Decision Support (CDS) tool with Nudges

Behavioral

The CDS tool with nudges provide information to providers to practice medicine in accordance with CT (computed tomography) ordering guidelines. The tool will only deploy when the provider is going against clinical guidelines and therefore provides a chance for the provider to reconsider their actions.

Primary outcomes

Percentage of CT scan orders that are guideline-concordant

Time frame: Baseline (Month 12)

Guideline-concordant is defined as CT scan orders with Wells' Score >4 ["PE Likely"] and/or d-dimer above upper limit of normal.
Percentage of CT scan orders that are guideline-concordant

Time frame: End of intervention (Month 45)

Guideline-concordant is defined as CT scan orders with Wells' Score >4 ["PE Likely"] and/or d-dimer above upper limit of normal.

Study contacts

Contact information is provided by the study sponsor or research team.

Lynn Xu

CONTACT

[email protected]

646-501-7911

Natalie Henning

CONTACT

[email protected]

239-810-1186

Sponsors and collaborators

Lead sponsor

NYU Langone Health

Other

Collaborators

National Heart, Lung, and Blood Institute (NHLBI)

Registry information

Important dates

Study start: 2026
Primary completion: 2028
Study completion: 2029
First posted: Nov 25, 2025
Registry last updated: Jan 22, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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