Real-time clinical alerting: effect of an automated paging system on response time to critical laboratory values--a randomised controlled trial

Etchells, Edward; Adhikari, Neill K. J.; Cheung, Christian P.; Fowler, Robert; Kiss, Alexander; Quan, Sherman; Sibbald, William J.; Wong, Brian M.

doi:10.1136/qshc.2008.028407

Cited by 39 publications

(39 citation statements)

References 9 publications

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“…Automated clinical surveillance systems are effective for a variety of clinical conditions including the identification of sepsis (19), adverse drug reactions (20,21), and more recently, AKI (22,23). These surveillance systems have assisted with faster identification of events compared with usual care that has been shown to improve shortterm progression of AKI severity (22,24,25). Future studies are needed to determine the effect of clinical surveillance systems used to detect AKI on long-term recovery of renal function, as well as how these systems can be further refined to enhance the detection and management of AKI.…”

Section: Discussionmentioning

confidence: 99%

AKI in Low-Risk versus High-Risk Patients in Intensive Care

Sileanu

Murugan

Lucko

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives AKI in critically ill patients is usually part of multiorgan failure. However, nonrenal organ failure may not always precede AKI and patients without evidence of these organ failures may not be at low risk for AKI. This study examined the risk and outcomes associated with AKI in critically ill patients with and without cardiovascular or respiratory organ failures at presentation to the intensive care unit (ICU).Design, setting, participants, & measurements A large, academic medical center database, with records from July 2000 through October 2008, was used and the authors identified a low-risk cohort as patients without cardiovascular and respiratory organ failures defined as not receiving vasopressor support or mechanical ventilation within the first 24 hours of ICU admission. AKI was defined using Kidney Disease Improving Global Outcomes criteria. The primary end points were moderate to severe AKI (stages 2-3) and risk-adjusted hospital mortality.Results Of 40,152 critically ill patients, 44.9% received neither vasopressors nor mechanical ventilation on ICU day 1. Stages 2-3 AKI occurred less frequently in the low-risk patients versus high-risk patients within 24 hours (14.3% versus 29.1%) and within 1 week (25.7% versus 51.7%) of ICU admission. Patients developing AKI in both risk groups had higher risk of death before hospital discharge. However, the adjusted odds of hospital mortality were greater (odds ratio, 2.99; 95% confidence interval, 2.62 to 3.41) when AKI occurred in low-risk patients compared with those with respiratory or cardiovascular failures (odds ratio, 1.19; 95% confidence interval, 1.09 to 1.3); interaction P,0.001.Conclusions Patients admitted to ICU without respiratory or cardiovascular failure have a substantial likelihood of developing AKI. Although survival for low-risk patients is better than for high-risk patients, the relative increase in mortality associated with AKI is actually greater for low-risk patients. Strategies aimed at preventing AKI should not exclude ICU patients without cardiovascular or respiratory organ failures.

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Section: Discussionmentioning

confidence: 99%

AKI in Low-Risk versus High-Risk Patients in Intensive Care

Sileanu

Murugan

Lucko

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…As Etchells et al [12] Laboratory medicine communities of practice may profit from the work already completed in other safety-critical industries. It would be worthwhile to review which of the effective practices developed in other industries can be translated to laboratory medicine critical value reporting.…”

Section: Future Research Needsmentioning

confidence: 99%

“…Table 1 provides the summary effectiveness data for the practice of automated notification. Etchells et al [12] reported the results of a computer system-driven paging system for communicating 165 critical values for 108 patients. After implementing an automated notification system, the median interval decreased from 39.5 to 16 minutes (p=0.33) between placement of the critical value into the laboratory information system to the writing of an order on the patient's chart in response to the critical value.…”

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confidence: 99%

“…Kuperman et al [11] similarly reported the results of a randomized control trial using a similar automated paging system in communicating 192 alerts (94 intervention, 98 controls) for 178 subjects. As shown in Table 1, only 1 of the 4 studies reporting findings was rated "good" [12], and only two reported sufficient data with which to calculate a standardized effect size ([10, 11];). Since the results being summarized are based on means, Cohen's d was selected to represent study findings [20].…”

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confidence: 99%

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Effectiveness of automated notification and customer service call centers for timely and accurate reporting of critical values: A laboratory medicine best practices systematic review and meta-analysis

Liebow

Derzon

Fontanesi

et al. 2012

Clinical Biochemistry

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Objective-To conduct a systematic review of automatic notification methods and consider evidence-based recommendations for best practices in improving the timeliness and accuracy of critical value reporting.Results-196 bibliographic records were identified, with nine meeting review inclusion criteria. Four studies examined automated notification systems and five assessed call center performance. Average improvement from implementing automated notification systems is d = 0.42 (95% CI = 0.2 -0.62) while the average odds ratio for call centers is OR = 22.1 (95% CI = 17.1 -28.6).Conclusions-The evidence, though suggestive, is not sufficient to make a recommendation for or against using automated notification systems as a best practice to improve the timeliness and accuracy of critical value reporting in an in-patient care setting. Call centers, however, are effective in improving the timeliness and accuracy of critical value reporting in an in-patient care setting, and are recommended as an "evidence-based best practice." KeywordsClinical laboratory information systems; critical care methods; hospital laboratory organization and administration; medical laboratory personnel organization and administration Corresponding Author: Edward Liebow, Battelle Centers for Public Health Research and Evaluation, 1100 Dexter Ave N, Suite 400, .6683, liebowe@battelle.org. Human Subjects ProtectionNo human subjects research was conducted for the purposes of the findings reported here. The attention directed towards improvements for critical value notification is driven by the assumption that timely reporting will lead to timely clinical interventions and corresponding secondary prevention of co-morbidities and more effective treatment outcomes. Despite the number of entities interested in improving critical value reporting, evidence has been lacking concerning which practices are effective at achieving these improvements. HHS Public AccessImplementing an effective critical value reporting system is concomitantly complex ( Figure 1 Quality Gap: Manual Notification of Critical ValuesThe standard notification mode in most healthcare facilities includes a manual process of contacting clinicians, connecting them to the laboratory, and conveying critical results verbally. When contact is not successfully completed, escalation procedures are followed, based on routing rules and procedures relevant to the indications for testing, the clinician who ordered the test, attending clinicians, and finally, supervising clinicians. This is often a time-consuming practice that diverts the laboratorian's attention from other laboratory work, frequently results in the handoff of information to an intermediary, and creates opportunities for transfer errors and reporting delays. Alternative mechanisms that have been instituted to replace the standard laboratory phone contact efforts include the use of automated notification systems and call centers (also known as "customer service centers"). Practice Descriptions MethodsThis evidence review ...

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“…Contacting a community requestor out of office hours requires substantial staff resource. It can be difficult to locate requestors 3,4 because after hours contact details have not been made available, the mobile phone has been switched off or the voicemail option is kept activated, the requestor is on leave or the duty doctor for a practice may refuse to accept the results because the patient is not known to them. Additionally, there may be uncertainty about the significance of the results.…”

Section: Introductionmentioning

confidence: 99%

Reflex testing to define action limits for community-based requests

Barron¹,

Ng²,

Aspin³

et al. 2012

Ann Clin Biochem

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Background: Critical values are required to be phoned 24/7. Other abnormal results fall short of the thresholds used to define critical values and may only be required to be phoned during the day. Community-based requestors prefer not to be contacted unless a result is critical and contacting them requires substantial staff resource. It is common practice to add tests to requests to expedite diagnosis or clarify the significance of a particular result using algorithms. Methods: We devised algorithms for reflex addition of tests which allowed the differentiation of significantly abnormal results as either critical values or those that only require day phoning. Results: Algorithms identified 158 out of 309 tests as being critical (51%) over nine months. Reflex addition of serum bicarbonate identified 4% of serum glucose (24.9 -37.9 mmol/L) as critical. Use of estimated glomerular filtration rate by reflex addition of serum creatinine identified 68% of serum lithium (1.49 -1.99 mmol/L) as critical. Addition of serum potassium, calcium and magnesium identified 21% of serum digoxin (.2.49 nmol/L) as critical and addition of serum potassium and calcium to all samples with serum magnesium (,0.31 mmol/L) identified hypocalcaemia in all cases. The addition of serum creatinine and potassium as markers for rhabdomyolysis-induced acute renal failure did not help in the differentiation of serum creatine kinase . 4999 m/L. Conclusions: Use of reflex tests helped inform a phoning system based on the division of results into critical values and nonemergency abnormal values. This avoids disturbing requestors unnecessarily and conserves staff time at night.

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Real-time clinical alerting: effect of an automated paging system on response time to critical laboratory values--a randomised controlled trial

Cited by 39 publications

References 9 publications

AKI in Low-Risk versus High-Risk Patients in Intensive Care

AKI in Low-Risk versus High-Risk Patients in Intensive Care

Effectiveness of automated notification and customer service call centers for timely and accurate reporting of critical values: A laboratory medicine best practices systematic review and meta-analysis

Reflex testing to define action limits for community-based requests

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