Distribution and Hospital Information System Acknowledgment Timeliness of Critical Value Reports in a Large Tertiary...

To describe the distribution of critical value reports, departmental patterns, and HIS-recorded acknowledgment timeliness in a large tertiary hospital in 2023 and to identify targets for process optimization.

Critical value reporting is a key healthcare quality and safety process, but whole-hospital evidence on item distribution, departmental variation, and HIS acknowledgment timeliness across high-load settings remains limited.

This retrospective, descriptive, observational study analyzed all consecutive laboratory-related critical value records from the Affiliated Hospital of Nantong University in 2023. Records with complete timestamps were included. Variables included test item, department, visit type, specimen collection time, result dispatch time, clinical recipient, and HIS acknowledgment time. HIS acknowledgment time was defined as the interval between result dispatch/reporting and the first documented clinical acknowledgment/response in the HIS. A timely HIS acknowledgment was defined as documented acknowledgment within 15 min; a delayed HIS acknowledgment was defined as documented HIS acknowledgment requiring more than 60 min. Data were analyzed descriptively using median with interquartile range and frequency with percentage.

A total of 53,639 critical value records were analyzed. The highest proportions were for WBC count (21.46%), microbial culture (14.10%), PLT count (12.97%), and cTnI (12.86%). The top departments were the hematology ward (22.13%), ICU (20.65%), and emergency department (17.46%). The overall median HIS acknowledgment time was 35 s (IQR 20-96 s), and the overall timely acknowledgment rate was 94.57%. The highest untimely acknowledgment rates were observed in the emergency department (9.53%), ICU (6.98%), and hematology outpatient clinic (6.39%). The highest delayed acknowledgment rates were observed in the hematology outpatient clinic (2.51%), emergency department (2.15%), and ICU (1.01%).

HIS-recorded critical value acknowledgment was generally timely, but untimely and delayed acknowledgment clustered in specific high-load departments. These findings can inform process optimization. Because clinical interventions and patient outcomes were not evaluated, no conclusions about patient safety outcomes can be drawn.

Nurse managers should ensure clear accountability for critical value acknowledgment, implement unit-level escalation protocols, monitor item- and department-level timeliness dashboards, support mobile alert access, and conduct regular audits and training, particularly in the emergency department, ICU, and hematology outpatient clinic.