TF-7 Zero Waste Emergency Medicine: A Visual Aid for Clinical Decision Rules in Minor Head Trauma Injury Patients

Abstract

Infographics are a novel educational tool that can bridge the gap between knowledge and translation of clinical decision rules (CDRs). They improve the dissemination of ideas through the practice of short eye-catching graphics that present seemingly complex ideas using easily understandable pictorials. They improve knowledge retention and learning interest. Our proposal is a curriculum designed to train faculty and resident physicians in the Choosing Wisely initiatives and to improve retention and application using infographics. We will focus on the use of computed tomography in minor head injury adult and pediatric patients. This project follows Kern’s approach to curriculum development focused on dissemination of clinical decision rules for head imaging in minor trauma in both adult and pediatric patients. Although these risk stratification tools have been taught in residency training for decades, their use for clinical decisionmaking in the workplace has been limited. This project aims to use industry-standard, well-designed infographics posted in the clinical areas of the ED to try to improve the accessibility and awareness of CDRs regarding head imaging in minor trauma. The goal is to improve risk communication to patients and decrease unnecessary imaging in our trauma patients. We hope to foster collaborative approaches to clinical decisionmaking for patients who are often cared for by an interdisciplinary team represented by surgery, emergency medicine, and pediatrics, often involving different learner levels. By placing these graphics in areas where clinical decisions are made, we hope to change low yield testing practices that lead to unnecessary use of advanced imaging. An international, multiple disciplinary team developed a designed-centered visual aid for the PECARN Head CT Rule, and the Canadian Head CT Rule. These are both CDRs used to identify patients who can be discharged without imaging in minor head trauma. Faculty and residents in the department of emergency medicine were surveyed to assess familiarity with the Choosing Wisely Campaign, CDRs in minor head trauma, and the frequency of CDR use in clinical practice. The final portions of this survey compare our intervention visual aid to a prior designed graphic disseminated from ACEP. We plan to disseminate these infographics by posting them in the resuscitation rooms and clinical areas of the Zuckerberg San Francisco General (ZSFG) emergency department in large poster format. When surveyed on use on CDRs in clinical practice, 65.2% of respondents state they “always” or “mostly” use CDRs when risk stratifying adult patients with head trauma compared to 94.2% in pediatric head trauma. In comparing our visual aid to a prior released visual aid from ACEP, 58% of respondents preferred our visual aid when communicating the CDR to another provider, and 73% preferred our visual aid when communicating the CDR to a novice learner. Many emergency medicine residents and attendings use clinical decision rules in daily practice. A simple, industry-standard visual aid for use of computed tomography in minor head injury adult and pediatric patients may improve in education of learners and providers in the team-based clinical setting.