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

Area of Science:

• Emergency Medicine
• Health Informatics
• Clinical Decision Support

Background:

• Emergency department (ED) patient care relies heavily on diagnostic test results, often with delays between result availability and physician action.
• A lag time exists between test results becoming available and physician decision-making or patient disposition.
• A novel system using smartphone and smartwatch push notifications was implemented to alert ED providers to available test results.

Purpose of the Study:

• To evaluate the impact of a push notification system on reducing the time from diagnostic test result availability to physician decision-making or follow-up orders in the ED.
• To assess the effectiveness of electronic alerts in streamlining clinical workflows.
• To determine the provider adoption rate of the push notification system.

Main Methods:

• A retrospective study was conducted across three EDs, analyzing a one-year period of push notification availability.
• The study examined six clinical scenarios: 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.
• The primary outcome was the median time from result availability to disposition or follow-up order; the secondary outcome was system usage rate.

Main Results:

• Five of the six clinical scenarios showed a statistically significant decrease in median time from test result to disposition or follow-up order with the push notification system.
• Reductions in median time varied by scenario, with notable decreases for UA (50 minutes), RPP (43 minutes), and CXR (24 minutes).
• The push notification system was utilized in 2.7% of ED encounters, indicating low adoption rates.

Conclusions:

• The implementation of a push notification system for test result availability in the ED is associated with reduced lag times to physician decision-making in several key clinical scenarios.
• Despite demonstrated benefits in reducing decision times, the system's usage was limited to a minority of ED patient encounters.
• Further strategies may be needed to increase provider adoption and maximize the benefits of this technology.