Randomise or Randomize? Updated 3/1/2018

Update 3/1/2018: The “randomise” web site has been hijacked and is no longer valid.

So  I saw Psych Practice bloggers recent post about a fun way to learn more about randomized trials.

I deliberately spelled “randomized” with an “z” instead of a “s.” This is just to get your attention, because the web site Randomise Me (no longer valid) is a beta from a talented person with a sense of humor who’s obviously in the United Kingdom.

I’ve been pondering over the instructions (no longer available). I’ve been trying to persuade non-psychiatric resident physicians to use the new order set for delirium in our electronic health record, which is Epic. I got the idea a few months ago when Dr. Paul Thisayakorn sat in on one of our psychiatry consultation services case conferences (Clinical Problems in Consultation Psychiatry or CPCP). Paul told us about his own practice improvement project he was developing during his rotation on the Palliative Medicine service, which sees a lot of patients who struggle with delirium.

Paul wanted to promote the use of the new Epic Delirium Order Set, which I’ve previously posted. Here’s a direct link to the order set.

I’ve been wondering whether or not I’d get fewer consultation requests for delirium if the residents just used the Epic Delirium Order Set. So could we compare two inpatient general medicine units and see how many consultation requests we get from the unit in which residents use the order set versus the unit in which they don’t?

I’m a-roll-up-your-sleeves clinical track psychiatric consultant, not a researcher, so I may have this all wrong, but here’s how I might set it up per the tutorial:

Create a Trial Question: Does using the Epic Delirium Order Set cut down on the number of psychiatry consults for delirium?

Main Outcome Measure: Number of psychiatry consults.

Size of Trial: I’m not sure but we get about 100 consultations a month and at least 20% are for delirium.

Description of Trial: A randomized trial comparing the number of psychiatry consult requests between general medicine units which either do or don’t use the Epic Delirium Order Set. I expect the number of consult requests would be lower from the unit which uses the order set.

Trial Instructions: Residents on the test unit will enter the Delirium Order Set upon either learning of a positive Delirium Observation Screening Scale (DOSS) score from nurses or diagnosing delirium themselves by the informal use of the Confusion Assessment Method (CAM) and the Mini-Cog. Residents on the control unit will not enter the Delirium Order Set under the same conditions.

Now I FULLY EXPECT to get some criticism about this, which is why I have not yet signed up to create my own trial.  I ran it by Pain-in-the-Butt Spokescanine.dogThe reaction was predictable.

dog nap

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