Lessons learned from implementation of a computerized application for pending tests at hospital discharge

Area of Science:

• Health Informatics
• Patient Safety
• Clinical Workflow Management

Background:

• Poor awareness of final test results post-discharge is a significant patient safety concern.
• Limited computerized systems exist to manage test results during care transitions.
• Inpatient physicians require effective tools for managing pending test results.

Purpose of the Study:

• To implement and evaluate a computerized application for inpatient physicians to manage pending test results at hospital discharge.
• To identify physician usage, satisfaction, and barriers related to a test results management application.
• To understand physician perspectives on the ideal system for managing post-discharge test results.

Main Methods:

• Modified an ambulatory electronic medical record (EMR)-based results management application (Hospitalist Results Manager, HRM).
• Trained inpatient physicians at two academic medical centers on using the HRM application.
• Surveyed physicians on HRM usage, satisfaction, barriers, and desired features for an ideal system.

Main Results:

• Low adoption rates: 48% never used HRM, 45% used it 1-2 times/week.
• Significant barriers reported: information overload, time constraints, lack of workflow integration (79%).
• High demand for improved functionality: 72% desired notifications for abnormal/clinician-designated results; 93% saw value in an ideal system.

Conclusions:

• Inpatient physicians recognize the value of computerized systems for managing discharge test results.
• Current systems face adoption and usage barriers, including workflow integration and result relevance.
• Future electronic systems should address these barriers and incorporate desired features for optimal effectiveness.