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Use of clinical prediction rules (CPRs) can reduce inappropriate antibiotic prescribing but they remain underutilized by physicians and advanced practice providers. A registered nurse (RN)-led model of an electronic health record-integrated CPR (iCPR) for low-acuity ARIs may be an effective alternative to address the barriers to a physician-driven model.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Following qualitative usability testing, we will conduct a stepped-wedge practice-level cluster randomized controlled trial (RCT) examining the effect of iCPR-guided RN care for low acuity patients with ARI. The primary hypothesis to be tested is: Implementation of RN-led iCPR tools will reduce antibiotic prescribing across diverse primary care settings. Specifically, this study aims to: (1) determine the impact of iCPRs on rapid strep test and chest x-ray ordering and antibiotic prescribing rates when used by RNs; (2) examine resource use patterns and cost-effectiveness of RN visits across diverse clinical settings; (3) determine the impact of iCPR-guided care on patient satisfaction; and (4) ascertain the effect of the intervention on RN and physician burnout.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>This study represents an innovative approach to using an iCPR model led by RNs and specifically designed to address inappropriate antibiotic prescribing. This study has the potential to provide guidance on the effectiveness of delegating care of low-acuity patients with ARIs to RNs to increase use of iCPRs and reduce antibiotic overprescribing for ARIs in outpatient settings.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ClinicalTrials.gov Identifier: NCT04255303, Registered February 5 2020, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04255303\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04255303<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-023-02368-0","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T12:02:10Z","timestamp":1699963330000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial"],"prefix":"10.1186","volume":"23","author":[{"given":"Elizabeth R.","family":"Stevens","sequence":"first","affiliation":[]},{"given":"Ruth","family":"Agbakoba","sequence":"additional","affiliation":[]},{"given":"Devin M.","family":"Mann","sequence":"additional","affiliation":[]},{"given":"Rachel","family":"Hess","sequence":"additional","affiliation":[]},{"given":"Safiya I.","family":"Richardson","sequence":"additional","affiliation":[]},{"given":"Thomas","family":"McGinn","sequence":"additional","affiliation":[]},{"given":"Paul D.","family":"Smith","sequence":"additional","affiliation":[]},{"given":"Wendy","family":"Halm","sequence":"additional","affiliation":[]},{"given":"Marlon P.","family":"Mundt","sequence":"additional","affiliation":[]},{"given":"Katherine L.","family":"Dauber-Decker","sequence":"additional","affiliation":[]},{"given":"Simon A.","family":"Jones","sequence":"additional","affiliation":[]},{"given":"Dawn M.","family":"Feldthouse","sequence":"additional","affiliation":[]},{"given":"Eun Ji","family":"Kim","sequence":"additional","affiliation":[]},{"given":"David A.","family":"Feldstein","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"key":"2368_CR1","unstructured":"Centers for Disease Control and Prevention. 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This research protocol was reviewed and approved by the NYU School of Medicine and NYU Langone Health Institutional Review Board (NYULH Study Number: i19-01222). Informed consent will be obtained from all the participants and\/or their legal guardians. For patients, the NYU Langone Health IRB waived the informed consent. NYU served as the central IRB for this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"260"}}