Related Experiment Video
Updated: Nov 7, 2025
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Performance of an Electronic Decision Support System as a Therapeutic Intervention During a Multicenter PICU Clinical
Eliotte L Hirshberg1, Jamin L Alexander2, Lisa A Asaro3
1Pulmonary Division, Intermountain Medical Center, Salt Lake City, UT; Center for Humanizing Critical Care, Intermountain Healthcare, Salt Lake City, UT; Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT; Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, UT.
Insights
Clinical decision support (CDS) systems like CHECKS improve hyperglycemia management in pediatric critical care. High user compliance with CHECKS in the HALF-PINT trial ensured consistent patient care across diverse settings.
Area of Science:
- Pediatric Critical Care Medicine
- Health Informatics
- Clinical Trial Management
Background:
- Electronic clinical decision support (CDS) systems are infrequently utilized in pediatric critical care trials.
- The study details the application of the Children's Hospital Euglycemia for Kids Spreadsheet (CHECKS) CDS tool.
- CHECKS was implemented for hyperglycemia management during the multicenter Heart And Lung Failure-Pediatric Insulin Titration (HALF-PINT) trial.
Purpose of the Study:
- To assess user compliance with the CHECKS CDS tool in critically ill pediatric patients.
- To investigate the association between CHECKS compliance and patient outcomes, specifically blood glucose control.
- To identify patient and clinician factors influencing CHECKS compliance and usage patterns.
Main Methods:
- An observational retrospective study analyzed compliance with CHECKS during the prospective HALF-PINT randomized controlled trial.
- Patients were categorized into high and low CHECKS compliance groups.
- A user, function, representation, and task analysis (UFRTA) framework was employed to categorize user interactions and overrides.
Main Results:
- High overall compliance (median 99.5%) with CHECKS was observed across 658 pediatric patients.
- Low compliance (<90%) was associated with younger patients, less inotropic support, and assignment to a lower blood glucose target.
- The majority of overrides (89%) were user-initiated, with patient factors contributing 29%.
Conclusions:
- The CHECKS CDS tool facilitated a reproducible and explicit approach to hyperglycemia management in critically ill children.
- CDS systems are valuable tools for conducting complex pediatric critical care trials effectively.
- Future trials can benefit from understanding factors influencing CDS compliance to optimize trial execution and outcomes.
Background:
The use of electronic clinical decision support (CDS) systems for pediatric critical care trials is rare. We sought to describe in detail the use of a CDS tool (Children's Hospital Euglycemia for Kids Spreadsheet [CHECKS]), for the management of hyperglycemia during the 32 multicenter Heart And Lung Failure-Pediatric Insulin Titration trial.
Research Question:
In critically ill pediatric patients who were treated with CHECKS, how was user compliance associated with outcomes; and what patient and clinician factors might account for the observed differences in CHECKS compliance?
Study Design And Methods:
During an observational retrospective study of compliance with a CDS tool used during a prospective randomized controlled trial, we compared patients with high and low CHECKS compliance. We investigated the association between compliance and blood glucose metrics. We describe CHECKS and use a computer interface analysis framework (the user, function, representation, and task analysis framework) to categorize user interactions. We discuss implications for future randomized controlled trials.
Results:
Over a 4.5-year period, 658 of 698 children were treated with the CHECKS protocol for ≥24 hours with a median of 119 recommendations per patient. Compliance per patient was high (median, 99.5%), with only 30 patients having low compliance (<90%). Patients with low compliance were from 16 of 32 sites, younger (P = .02), and less likely to be on inotropic support (P = .04). They were more likely to be have been assigned randomly to the lower blood glucose target (80% vs 48%; P < .001) and to have spent a shorter time (53% vs 75%; P < .001) at the blood glucose target. Overrides (classified by the user, function, representation, and task analysis framework), were largely (89%) due to the user with patient factors contributing 29% of the time.
Interpretation:
The use of CHECKS for the Heart And Lung Failure-Pediatric Insulin Titration trial resulted in a highly reproducible and explicit method for the management of hyperglycemia in critically ill children across varied environments. CDS systems represent an important mechanism for conducting explicit complex pediatric critical care trials.
Clinical Trial Registration:
ClinicalTrials.gov Identifier: NCT01565941, registered March 29 2012; https://clinicaltrials.gov/ct2/show/NCT01565941?term=HALF-PINT&draw=2&rank=1.
More Related Videos
04:53A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
09:31Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism
Published on: February 14, 2022
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
01:16Insulin: Dosing Regimen and Adverse Effects
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...