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Real-time automated paging and decision support for critical laboratory abnormalities
Edward Etchells1, Neill K J Adhikari, Robert Wu
1Centre for Patient Safety, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada. edward.etchells@syunnybrook.ca
BMJ Quality & Safety
|July 5, 2011
Summary
A real-time clinical alerting system for critical lab abnormalities did not improve patient care. The system failed to increase completed clinical actions or reduce adverse events, showing no significant benefit.
Area of Science:
- Medical Informatics
- Clinical Decision Support
- Patient Safety
Background:
- Critical laboratory abnormalities require timely management to prevent adverse events.
- Clinical alerts and decision support systems aim to improve patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a real-time clinical alerting system with decision support for critical laboratory abnormalities.
- To assess the impact on clinical action completion and patient adverse events.
Main Methods:
- A prospective controlled stepped-wedge study was conducted in general internal medicine units at two academic hospitals.
- A real-time alerting system sent critical lab abnormality alerts via text message or pager, with decision support accessible via smartphone or intranet.
- Outcomes measured included the proportion of completed clinical actions and the occurrence of adverse events within 48 hours.
Main Results:
- The study evaluated 498 laboratory conditions in 271 patients.
- The alerting system did not significantly improve the proportion of completed clinical actions (50% with system on vs. 50% with system off).
- Adverse events occurred in 42% of alerts with the system on, compared to 33% with the system off, indicating a potential increase in adverse events.
Conclusions:
- Real-time clinical alerts and decision support for critical laboratory abnormalities did not enhance clinical management.
- The implemented system did not lead to a decrease in adverse events for patients with critical laboratory findings.
