Improving diagnostic safety through STeatosis Identification, Risk stratification, and Referral pathway in the ED...

Area of Science:

• Hepatology
• Implementation Science
• Clinical Informatics

Background:

• Incidental hepatic steatosis (fatty liver) is common in emergency department (ED) patients but often goes unreported.
• Lack of notification can delay diagnosis of metabolic associated steatotic liver disease (MASLD) and hinder management.
• This study addresses the critical gap in communicating incidental hepatic steatosis findings to patients.

Purpose of the Study:

• To evaluate an electronic health record (EHR)-delivered intervention (STIRRED) for notifying ED patients about incidental hepatic steatosis.
• To improve the rate of new steatotic liver disease-related diagnoses in high-risk patients post-discharge.
• To assess the implementation fidelity of the STIRRED system in real-world clinical settings.

Main Methods:

• A Stepped Wedge-Cluster Randomized Trial design involving 11 EDs.
• The STeatosis Identification, Risk stratification, and Referral pathway in the ED (STIRRED) clinical decision support system integrated into the EHR.
• Analysis of approximately 4700 patients with incidental hepatic steatosis, including 616 high-risk patients.

Main Results:

• The primary effectiveness outcome is the receipt of a new steatotic liver disease-related diagnosis within 120 days post-ED discharge.
• The primary implementation outcome is fidelity, measuring adherence to the STIRRED protocol.
• The study is powered to detect a significant difference in diagnosis rates between the intervention and usual care.

Conclusions:

• The STIRRED trial utilizes EHRs to provide clinicians with risk stratification and referral recommendations for incidental hepatic steatosis.
• The study employs rigorous implementation science methods to ensure intervention usability and scalability.
• This approach aims to enhance patient notification and facilitate timely diagnosis and management of fatty liver disease.