New York University School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York City, New York.
New York University School of Medicine, Department of Medicine, New York City, New York.
West J Emerg Med. 2019 Jul;20(4):666-671. doi: 10.5811/westjem.2019.5.42749. Epub 2019 Jul 1.
Emergency department (ED) patient care often hinges on the result of a diagnostic test. Frequently there is a lag time between a test result becoming available for review and physician decision-making or disposition based on that result. We implemented a system that electronically alerts ED providers when test results are available for review via a smartphone- and smartwatch-push notification. We hypothesized this would reduce the time from result to clinical decision-making.
We retrospectively assessed the impact of the implementation of a push notification system at three EDs on time-to-disposition or time-to-follow-up order in six clinical scenarios of interest: 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. All ED patients during a one-year period of push-notification availability were included in the study. The primary outcome was median time in each scenario from result availability to either disposition order or defined follow-up order. The secondary outcome was the overall usage rate of the opt-in push notification system by providers.
During the study period there were 6115 push notifications from 4183 ED encounters (2.7% of all encounters). Of the six clinical scenarios examined in this study, five were associated with a decrease in median time from test result availability to patient disposition or follow-up order when push notifications were employed: CXR to disposition, 80 minutes (interquartile range [IQR] 32-162 minutes) vs 56 minutes (IQR 18-141 minutes), difference 24 minutes (p<0.01); BMP to disposition, 128 minutes (IQR 62-225 minutes) vs 116 minutes (IQR 33-226 minutes), difference 12 minutes (p<0.01); UA to disposition, 105 minutes (IQR 43-200 minutes) vs 55 minutes (IQR 16-144 minutes), difference 50 minutes (p<0.01); RPP to disposition, 80 minutes (IQR 28-181 minutes) vs 37 minutes (IQR 10-116 minutes), difference 43 minutes (p<0.01); and D-dimer to CTPA, 14 minutes (IQR 6-30 minutes) vs 6 minutes (IQR 2.5-17.5 minutes), difference 8 minutes (p<0.01). The sixth scenario, Hb to blood transfusion (difference 19 minutes, p=0.73), did not meet statistical significance.
Implementation of a push notification system for test result availability in the ED was associated with a decrease in lag time between test result and physician decision-making in the examined clinical scenarios. Push notifications were used in only a minority of ED patient encounters.
急诊科（ED）患者的护理通常取决于诊断测试的结果。在测试结果可供审查和医生根据该结果做出决策或处置之间，通常存在时间延迟。我们实施了一种系统，通过智能手机和智能手表推送通知，在测试结果可供审查时向 ED 提供者发出电子警报。我们假设这将减少从结果到临床决策的时间。
我们回顾性评估了在三个 ED 实施推送通知系统对六个临床感兴趣场景中处置或随访医嘱时间的影响：胸部 X 光片（CXR）到处置、基本代谢小组（BMP）到处置、尿液分析（UA）到处置、呼吸道病原体小组（RPP）到处置、血红蛋白（Hb）到输血医嘱，以及异常 D-二聚体到计算机断层肺动脉造影（CTPA）医嘱。在推送通知可用的一年期间，所有 ED 患者均纳入研究。主要结局是每个场景中从结果可用到处置医嘱或定义的随访医嘱的中位数时间。次要结局是提供者对可选推送通知系统的总体使用率。
在研究期间，从 4183 次 ED 就诊中发出了 6115 次推送通知（占所有就诊的 2.7%）。在本研究检查的六个临床场景中，当使用推送通知时，五个与从测试结果可用性到患者处置或随访医嘱的中位数时间缩短有关：CXR 到处置，80 分钟（四分位距 [IQR] 32-162 分钟）与 56 分钟（IQR 18-141 分钟），差异 24 分钟（p<0.01）；BMP 到处置，128 分钟（IQR 62-225 分钟）与 116 分钟（IQR 33-226 分钟），差异 12 分钟（p<0.01）；UA 到处置，105 分钟（IQR 43-200 分钟）与 55 分钟（IQR 16-144 分钟），差异 50 分钟（p<0.01）；RPP 到处置，80 分钟（IQR 28-181 分钟）与 37 分钟（IQR 10-116 分钟），差异 43 分钟（p<0.01）；和 D-二聚体到 CTPA，14 分钟（IQR 6-30 分钟）与 6 分钟（IQR 2.5-17.5 分钟），差异 8 分钟（p<0.01）。第六个场景，Hb 到输血（差异 19 分钟，p=0.73），没有达到统计学意义。
在 ED 中实施测试结果可用性的推送通知系统与测试结果和医生决策之间的滞后时间缩短有关，在检查的临床场景中。推送通知仅在少数 ED 患者就诊中使用。
