Push-Alert Notification of Troponin Results to Physician Smartphones Reduces the Time to Discharge Emergency Department Patients: A Randomized Controlled Trial

Verma, Aikta; Wang, Angela S.; Feldman, Michael J.; Hefferon, D.; Kiss, Alex; Lee, Jacques

doi:10.1016/j.annemergmed.2017.03.021

Cited by 13 publications

(10 citation statements)

References 10 publications

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“…The overall magnitude of improvements observed in our study is similar to a trial of smartphone, troponin-result push notifications, in which Verma et al found a 26-minute improvement in lag time from troponin result to patient disposition 11. Our institution almost exclusively uses a point-of-care troponin test in the ED and thus we could not study the specific clinical scenario of troponin to disposition in our study.…”

Section: Discussionsupporting

confidence: 81%

“…Delays in responding to newly resulted test information (due to task-switching, interruptions, and other challenges of the ED clinical environment) likely impact patient throughput 9,10. Electronic systems that wirelessly alert providers about timed events have been shown to improve throughput in ED patients evaluated for chest pain 11,12. These alerts also increase the likelihood of the result reaching the provider and help avoid potential errors in communication of test results 13…”

Section: Introductionmentioning

confidence: 99%

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Decreasing the Lag Between Result Availability and Decision-Making in the Emergency Department Using Push Notifications

Swartz

Iturrate

Levy-Lambert

et al. 2019

WestJEM

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Introduction Emergency department (ED) patient care often hinges on the result of a diagnostic test. Frequently there is a lag time between a test result becoming available for review and physician decision-making or disposition based on that result. We implemented a system that electronically alerts ED providers when test results are available for review via a smartphone- and smartwatch-push notification. We hypothesized this would reduce the time from result to clinical decision-making. Methods We retrospectively assessed the impact of the implementation of a push notification system at three EDs on time-to-disposition or time-to-follow-up order in six clinical scenarios of interest: chest radiograph (CXR) to disposition, basic metabolic panel (BMP) to disposition, urinalysis (UA) to disposition, respiratory pathogen panel (RPP) to disposition, hemoglobin (Hb) to blood transfusion order, and abnormal D-dimer to computed tomography pulmonary angiography (CTPA) order. All ED patients during a one-year period of push-notification availability were included in the study. The primary outcome was median time in each scenario from result availability to either disposition order or defined follow-up order. The secondary outcome was the overall usage rate of the opt-in push notification system by providers. Results During the study period there were 6115 push notifications from 4183 ED encounters (2.7% of all encounters). Of the six clinical scenarios examined in this study, five were associated with a decrease in median time from test result availability to patient disposition or follow-up order when push notifications were employed: CXR to disposition, 80 minutes (interquartile range [IQR] 32–162 minutes) vs 56 minutes (IQR 18–141 minutes), difference 24 minutes (p<0.01); BMP to disposition, 128 minutes (IQR 62–225 minutes) vs 116 minutes (IQR 33–226 minutes), difference 12 minutes (p<0.01); UA to disposition, 105 minutes (IQR 43–200 minutes) vs 55 minutes (IQR 16–144 minutes), difference 50 minutes (p<0.01); RPP to disposition, 80 minutes (IQR 28–181 minutes) vs 37 minutes (IQR 10–116 minutes), difference 43 minutes (p<0.01); and D-dimer to CTPA, 14 minutes (IQR 6–30 minutes) vs 6 minutes (IQR 2.5–17.5 minutes), difference 8 minutes (p<0.01). The sixth scenario, Hb to blood transfusion (difference 19 minutes, p=0.73), did not meet statistical significance. Conclusion Implementation of a push notification system for test result availability in the ED was associated with a decrease in lag time between test result and physician decision-making in the examined clinical scenarios. Push notifications were used in only a minority of ED patient encounters.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Decreasing the Lag Between Result Availability and Decision-Making in the Emergency Department Using Push Notifications

Swartz

Iturrate

Levy-Lambert

et al. 2019

WestJEM

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“…However, neither the use of the DL-algorithm nor the use of the ENS led to a statistically significant reduction of RCT and TAT. Other studies have shown positive effects of ENS on interdisciplinary communication [12,26], documentation [27] and patient flow in the ED [28,29].…”

Section: Discussionmentioning

confidence: 99%

Deep learning-based automated detection of pulmonary embolism on CT pulmonary angiograms: No significant effects on report communication times and patient turnaround in the emergency department nine months after technical implementation

Schmuelling

Franzeck

Nickel

et al. 2021

European Journal of Radiology

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Rapid communication of CT exams positive for pulmonary embolism (PE) is crucial for timely initiation of anticoagulation and patient outcome. It is unknown if deep learning automated detection of PE on CT Pulmonary Angiograms (CTPA) in combination with worklist prioritization and an electronic notification system (ENS) can improve communication times and patient turnaround in the Emergency Department (ED). Methods: In 01/2019, an ENS allowing direct communication between radiology and ED was installed. Starting in 10/2019, CTPAs were processed by a deep learning (DL)-powered algorithm for detection of PE. CTPAs acquired between 04/2018 and 06/2020 (n = 1808) were analysed. To assess the impact of the ENS and the DL-algorithm, radiology report reading times (RRT), radiology report communication time (RCT), time to anticoagulation (TTA), and patient turnaround times (TAT) in the ED were compared for three consecutive time periods. Performance measures of the algorithm were calculated on a per exam level (sensitivity, specificity, PPV, NPV, F1score), with written reports and exam review as ground truth. Results: Sensitivity of the algorithm was 79.6 % (95 %CI:70.8− 87.2%), specificity 95.0 % (95 %CI:92.0− 97.1%), PPV 82.2 % (95 %CI:73.9− 88.3), and NPV 94.1 % (95 %CI:91.4-96 %). There was no statistically significant reduction of any of the observed times (RRT, RCT, TTA, TAT). Conclusion: DL-assisted detection of PE in CTPAs and ENS-assisted communication of results to referring physicians technically work. However, the mere clinical introduction of these tools, even if they exhibit a good performance, is not sufficient to achieve significant effects on clinical performance measures.

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“…As a simple, entertaining game, the PrEDICT has potential for use as a repeated delirium self‐assessment tool by patients. Push notification technology could alert ED staff when a patient shows significant decline in test performance . We plan to compare the acceptability, adoption, and diagnostic accuracy of PrEDICT to existing validated delirium screening tools in a pragmatic, multicenter study.…”

Section: Discussionmentioning

confidence: 99%

Predictive Ability of a Serious Game to Identify Emergency Patients With Unrecognized Delirium

Lee

Tong

Tierney

et al. 2019

J American Geriatrics Society

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OBJECTIVES Recognition of delirium in the emergency department (ED) is poor. Our objectives were to assess: (1) the diagnostic accuracy of the Predicting Emergency department Delirium with an Interactive Computer Tablet (PrEDICT) “serious game” to identify older ED patients with delirium compared to clinical recognition and (2) the feasibility of the PrEDICT application compared to existing tests of attention. DESIGN Prospective observational study. SETTING ED of a Canadian tertiary care center. PARTICIPANTS We included ED patients, aged 70 years and older, with a minimum 4‐hour stay. We excluded anyone with critical illness, communication barriers, and visual impairment or those unable to use a computer tablet. None had prevalent delirium by ED clinicians' routine clinical assessment. MEASUREMENTS Participants were asked to tap targets on a tablet at four difficulty levels. Time and accuracy were automatically recorded. Other measures included the Confusion Assessment Method, the Delirium Severity Index, the Digit Vigilance Test (DVT), and the Choice Reaction Test (CRT). RESULTS We enrolled 203 patients. Their average age was 80.6 years, 49.8% were female, and their average ED length of stay was 15.9 hours. Sixteen subjects had clinically unrecognized delirium, and 14 of them completed the PrEDICT game (87.5%). We developed a threshold score with 100% sensitivity (95% confidence interval [CI] = 76.8%‐100.0%) and 59.7% specificity (95% CI = 52.3%‐66.6%) to identify patients with clinically unrecognized delirium. The area under the curve was 0.86 (95% CI = 0.77‐0.94). Completion rates were 196/203 (96.6%) for the PrEDICT serious game compared to 128/203 (63.1%) for the CRT and 51/203 (25.1%) for the DVT. CONCLUSION Older ED patients were able to use our serious game, including 87.5% of those with clinically unrecognized delirium. The PrEDICT application has potential to act as a sensitive screening tool to identify older ED patients with clinically unrecognized delirium. J Am Geriatr Soc 67:2370–2375, 2019

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Push-Alert Notification of Troponin Results to Physician Smartphones Reduces the Time to Discharge Emergency Department Patients: A Randomized Controlled Trial

Cited by 13 publications

References 10 publications

Decreasing the Lag Between Result Availability and Decision-Making in the Emergency Department Using Push Notifications

Decreasing the Lag Between Result Availability and Decision-Making in the Emergency Department Using Push Notifications

Deep learning-based automated detection of pulmonary embolism on CT pulmonary angiograms: No significant effects on report communication times and patient turnaround in the emergency department nine months after technical implementation

Predictive Ability of a Serious Game to Identify Emergency Patients With Unrecognized Delirium

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