Dutta Sayon, Dunham Lisette, McEvoy Dustin S, Cash Rebecca E, Meeker Melissa A, White Benjamin A
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Mass General Brigham Digital, Boston, MA.
Mass General Brigham Digital, Boston, MA.
Ann Emerg Med. 2025 Jan;85(1):53-62. doi: 10.1016/j.annemergmed.2024.07.010. Epub 2024 Sep 24.
Emergency department (ED) crowding has multiple causative factors, including delayed patient throughput. Patient care efficiency may be improved by addressing delays in decisionmaking following diagnostic testing results. We examined the influence of sending subscribed result push notifications to ED clinicians' smartphones on reducing the time to disposition decision.
All ED patient visits between October 2022 and October 2023 with a laboratory or imaging result during the ED visit and a disposition within 6 hours of the last result were included. We identified whether the last resulted study before the ED disposition decision had a subscribed push notification by the clinician who dispositioned the patient. The primary outcome was the time between the last study result and the first disposition decision. Generalized estimating equation analysis was used to control for variables including patient demographics, clinical factors, and discharging clinician.
The final study population included 237,872 encounters. The median patient age was 50 years, and 55.6% of patients were women. During the study period, 27.1% of clinicians used push notifications at least once. Of unique orders, 1.5% had a subscribed result push notification, including 0.9% of laboratory orders and 4.7% of imaging orders. The time between last result to disposition decision was 18 minutes (95% confidence interval [CI] 15 to 21) faster when a push notification was requested.
Elective push notification of test results was associated with reduced time between the last laboratory or imaging result and ED disposition decision. Further study is needed to determine its effect on overall ED throughput.
急诊科拥挤有多种致病因素，包括患者周转延迟。通过解决诊断测试结果后决策延迟的问题，可能会提高患者护理效率。我们研究了向急诊科临床医生的智能手机发送订阅结果推送通知对缩短处置决策时间的影响。
纳入了2022年10月至2023年10月期间在急诊科就诊期间有实验室或影像检查结果且在最后结果后6小时内进行处置的所有急诊科患者就诊情况。我们确定了在急诊科处置决策前最后一个有结果的检查是否有负责处置该患者的临床医生订阅的推送通知。主要结局是最后一次检查结果与首次处置决策之间的时间。采用广义估计方程分析来控制包括患者人口统计学、临床因素和出院临床医生等变量。
最终研究人群包括237,872次就诊。患者年龄中位数为50岁，55.6%的患者为女性。在研究期间，27.1%的临床医生至少使用过一次推送通知。在所有独特的医嘱中，1.5%有订阅的结果推送通知，其中包括0.9%的实验室医嘱和4.7%的影像医嘱。当请求推送通知时，从最后结果到处置决策的时间快了18分钟（95%置信区间[CI]为15至21）。
选择性推送检查结果通知与缩短最后一次实验室或影像检查结果与急诊科处置决策之间的时间有关。需要进一步研究以确定其对急诊科整体周转的影响。
