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

Abstract

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.

Providers Electing to Receive Electronic Result Notifications: Demographics and Motivation

“…We examined use at the order-level, but low rates have been previously reported by Koziatek et al, who demonstrated only 2.7% of ED encounters with this similar style of notification. 17 Interestingly our results showed approximately one in six results (17.04%, 391/2,294) had more than one notification request associated with it, implying that multiple providers felt that the result warranted notification and may have been especially important to patient care. Despite a relatively small number of our overall orders having notifications, more than 15% of providers utilized the tool during the study period implying at least some perceived value in it, with a predominance toward use in the hospital setting.…”

“…To our knowledge, there is only one study (by Koziatek et al) that examines vendor-based elective electronic notifications on patient care, and it is limited to the ED setting. 17 Even less is known about what motivates a provider to be notified at the time of elective notification.…”

“…Koziatek et al studied a vendor-based elective solution in their emergency department (ED) and demonstrated a reduction in time between the test result and decision-making, though the tool was not routinely used. 17…”

Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial

“…An extensive number of publications have also examined the impact of alert notifications on critical laboratory results. Although sometimes contradictory or pointing out the risk of alert fatigue potentially slowing the response to these alerts and harmful to the patient [ 43 , 44 , 45 ], they mostly show a significant reduction in time lag between laboratory result availability and decision making, a high degree of clinician approval, and a beneficial impact on patient care [ 25 , 46 , 47 , 48 , 49 ]. During 2018, there were an estimated 130 million ED visits in the USA.…”