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Critical Test Result Recall Supporting System (CTR RSS) Improves Follow-Up among Patients in the Community. Diagnostics (Basel) 2022; 12:diagnostics12051252. [PMID: 35626408 PMCID: PMC9141574 DOI: 10.3390/diagnostics12051252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Follow-up care of patients in the community is an important topic for improving patient outcomes, especially when medical personnel receives a notification of the critical test result (CTR) when the CTR becomes available after patients have been out of hospital; how to recall the patient back to the hospital and follow-up treatment is essential for preventing the healthcare risk of neglecting or delayed intervention with respect to the patient’s CTR. We are concerned that the follow-up of CTR and timely recall of our patients in the community improves and facilitates patient safety. We built the CTR Recall Supporting System (RSS) to follow up and recall our patients in the community. Measures were introduced to evaluate the effectiveness of CTR RSS; the rate of return of patients within 7 days increased from 58.5% to 88.8%, an increase of 30.3%, the patients in the community’s return follow-up interval days decreased from 10.9 days to 6.2 days, reduced by 4.7 days (p < 0.001), and the mortality rate of the patients in the community within 48 h decreased from 8.0% to 1.9%, a decrease of 6.1%, p < 0.001. The implementation of the CTR RSS significantly increases the discharged patient in he community’s CTR return follow-up within 7 days rate, decreases CTR return follow-up interval days, and reduces the CTR mortality rate within 48 h. This effectively improves the effects of CTR on return follow-up visits and provides a prototype system for hospitals that intend to improve this issue.
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Shriner AR, Baker RM, Ellis A, Dixon R, Saysana M. Improving Follow-Up of Tests Pending at Discharge. Hosp Pediatr 2021; 11:1363-1369. [PMID: 34849927 DOI: 10.1542/hpeds.2021-006000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Follow-up on results of inpatient tests pending at discharge (TPAD) must occur to ensure patient safety and high-quality care continue after discharge. We identified a need to improve follow-up of TPAD and began a quality improvement initiative with an aim of reducing the rate of missed follow-up of TPAD to ≤20% within 12 months. METHODS The team used the Plan-Do-Study-Act method of quality improvement and implemented a process using reminder messages in the electronic health record. We collected data via retrospective chart review for the 6 months before the intervention and monthly thereafter. The primary outcome measure was the percentage of patients with missed follow-up of TPAD, defined as no documented follow-up within 72 hours of a result being available. The use of a reminder message was monitored as a process measure. RESULTS We reviewed charts of 764 discharged patients, and 216 (28%) were noted to have TPAD. At baseline, the average percentage of patients with missed follow-up was 80%. The use of reminder messages was quickly adopted. The average percentage of patients with missed follow-up of TPAD after beginning the quality improvement interventions was 35%. CONCLUSIONS We had significant improvement in follow-up after our interventions. Additional work is needed to ensure continued and sustained improvement, focused on reducing variability in performance between providers and investing in technology to allow for automation of the follow-up process.
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Affiliation(s)
- Andrew R Shriner
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.,Department of Pediatrics, Section of Hospital Medicine School of Medicine, Indiana University, Indianapolis, Indiana
| | - Richelle M Baker
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.,Department of Pediatrics, Section of Hospital Medicine School of Medicine, Indiana University, Indianapolis, Indiana
| | - Andrew Ellis
- Mercy Children's Hospital, St Louis, Missouri.,Department of Child Health School of Medicine, University of Missouri, Columbia, Missouri
| | - Rebecca Dixon
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.,Department of Pediatrics, Section of Hospital Medicine School of Medicine, Indiana University, Indianapolis, Indiana
| | - Michele Saysana
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.,Department of Pediatrics, Section of Hospital Medicine School of Medicine, Indiana University, Indianapolis, Indiana
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Georgiou A, Li J, Thomas J, Dahm MR, Westbrook JI. The impact of health information technology on the management and follow-up of test results - a systematic review. J Am Med Inform Assoc 2020; 26:678-688. [PMID: 31192362 PMCID: PMC6562156 DOI: 10.1093/jamia/ocz032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To investigate the impact of health information technology (IT) systems on clinicians' work practices and patient engagement in the management and follow-up of test results. MATERIALS AND METHODS A search for studies reporting health IT systems and clinician test results management was conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect, ProQuest, and Scopus from January 1999 to June 2018. Test results follow-up was defined as provider follow-up of results for tests that were sent to the laboratory and radiology services for processing or analysis. RESULTS There are some findings from controlled studies showing that health IT can improve the proportion of tests followed-up (15 percentage point change) and increase physician awareness of test results that require action (24-28 percentage point change). Taken as whole, however, the evidence of the impact of health IT on test result management and follow-up is not strong. DISCUSSION The development of safe and effective test results management IT systems should pivot on several axes. These axes include 1) patient-centerd engagement (involving shared, timely, and meaningful information); 2) diagnostic processes (that involve the integration of multiple people and different clinical settings across the health care spectrum); and 3) organizational communications (the myriad of multi- transactional processes requiring feedback, iteration, and confirmation) that contribute to the patient care process. CONCLUSION Existing evidence indicates that health IT in and of itself does not (and most likely cannot) provide a complete solution to issues related to test results management and follow-up.
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Affiliation(s)
- Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Hisham S, Rasheed SA, Dsouza B. Application of Predictive Modelling to Improve the Discharge Process in Hospitals. Healthc Inform Res 2020; 26:166-174. [PMID: 32819034 PMCID: PMC7438692 DOI: 10.4258/hir.2020.26.3.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/21/2001] [Indexed: 11/23/2022] Open
Abstract
Objective To find out the factors influencing discharge process turnaround time (TAT) and to accurately predict the discharge process TAT. Methods The discharge process of cardiology department inpatients in a tertiary care hospital was mapped over a month. The likely factors influencing discharge TAT were tested for significance by ANOVA. Multiple linear regression (MLR) was used to predict the TAT. The sample was divided into testing and training sets for regression. A model was generated using the training set and compared with the testing set for accuracy. RESULTS After a process map was plotted, the significant factors influencing the TAT were identified to be the treating doctor, and pending evaluations on the day of discharge. The MLR model was developed with Python libraries based on the two factors identified. The model predicted the discharge TAT with a 69% R2 value and 32.4 minutes (standard error) on the testing set and a 77.3% R2 value and 26.7 minutes (standard error) on the overall sample. Conclusion This study was an initiation to find out factors influencing discharge TAT and how those factors can be used to predict discharge in the hospital of interest. The study was validated and predicted the TAT with 77% accuracy after the significant factors that affect the discharge process were identified.
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Affiliation(s)
- Sayed Hisham
- Healthcare Analytics, Baby Memorial Hospital, Kozhikode, India
| | - Shahina Abdul Rasheed
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Brayal Dsouza
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Li J, Paoloni R, Li L, Callen J, Westbrook JI, Runciman WB, Georgiou A. Does health information technology improve acknowledgement of radiology results for discharged Emergency Department patients? A before and after study. BMC Med Inform Decis Mak 2020; 20:100. [PMID: 32493463 PMCID: PMC7268495 DOI: 10.1186/s12911-020-01135-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The inadequate follow-up of test results is a key patient safety concern, carrying severe consequences for care outcomes. Patients discharged from the emergency department are at particular risk of having test results pending at discharge due to their short lengths of stay, with many hospitals acknowledging that they do not have reliable systems for managing such results. Health information technology hold the potential to reducing errors in the test result management process. This study aimed to measure changes in the proportion of acknowledged radiology reports pre and post introduction of an electronic result acknowledgement system and to determine the proportion of reports with abnormal results, including clinically significant abnormal results requiring follow-up action. METHODS A before and after study was conducted in the emergency department of a 450-bed metropolitan teaching hospital in Australia. All radiology reports for discharged patients for a one-month period before and after implementation of the electronic result acknowledgement system were reviewed to determine; i) those that reported abnormal results; ii) evidence of test result acknowledgement. All unacknowledged radiology results with an abnormal finding were assessed by an independent panel of two senior emergency physicians for clinical significance. RESULTS Of 1654 radiology reports in the pre-implementation period 70.6% (n = 1167) had documented evidence of acknowledgement by a clinician. For reports with abnormal results, 71.6% (n = 396) were acknowledged. Of 157 unacknowledged abnormal radiology reports reviewed by an independent emergency physician panel, 34.4% (n = 54) were identified as clinically significant and 50% of these (n = 27) were deemed to carry a moderate likelihood of patient morbidity if not followed up. Electronic acknowledgement occurred for all radiology reports in the post period (n = 1423), representing a 30.4% (95% CI: 28.1-32.6%) increase in acknowledgement rate, and an increase of 28.4% (95% CI: 24.6-32.2%) for abnormal radiology results. CONCLUSIONS The findings of this study demonstrate the potential of health information technology to improve the safety and effectiveness of the diagnostic process by increasing the rate of follow up of results pending at hospital discharge.
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Affiliation(s)
- Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia.
| | - Richard Paoloni
- Emergency Department, Concord Repatriation General Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Joanne Callen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - William B Runciman
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, Australia
- Australian Patient Safety Foundation, Adelaide, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
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Dahm MR, Georgiou A, Herkes R, Brown A, Li J, Lindeman R, Horvath AR, Jones G, Legg M, Li L, Greenfield D, Westbrook JI. Patient groups, clinicians and healthcare professionals agree - all test results need to be seen, understood and followed up. ACTA ACUST UNITED AC 2019; 5:215-222. [PMID: 30332391 DOI: 10.1515/dx-2018-0083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/25/2018] [Indexed: 11/15/2022]
Abstract
Background Diagnostic testing provides integral information for the prevention, diagnosis, treatment and management of disease. Inadequate test result reporting and follow-up is a major risk to patient safety. Factors contributing to failure to follow-up test results include unclear delineation of responsibility about who is meant to act on a test result; poor coordination across different levels of care; and the absence of integrated health information systems for the efficient information communication. Methods A 2016 Australian Stakeholder Forum brought together over 30 representatives from 14 different consumer, clinical and management stakeholder organisations to discuss safe and effective test result communication, management and follow-up. Thematic analysis was conducted drawing on multimodal data collected in the form of observational fieldnotes and document artefacts produced by participants. Results The forum identified major challenges which pose immediate risks to patient safety. Participants recommended priorities for addressing issues relating to: (i) the governance of test result management processes; (ii) integration of health care processes through the utilisation of effective digital health solutions; and (iii) involving patients as key partners in the decision-making and care process. Conclusions Stakeholder groups diverged slightly in their priorities. Consumers highlighted the lack of patient involvement in the test result management process but were less concerned about standardisation of reports and critical result thresholds than pathologists. The forum foregrounded the need for a systems approach, capable of identifying and addressing interconnections and multiple factors that contribute to poor test result follow-up, with a strong emphasis on enhancing the contribution of patients.
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Affiliation(s)
- Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robert Herkes
- Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Anthony Brown
- Health Consumers NSW, Sydney, NSW, Australia.,Men's Health Information and Resource Centre, Western Sydney University, Sydney, NSW, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robert Lindeman
- NSW Health Pathology, NSW Government, Sydney, NSW, Australia
| | - Andrea R Horvath
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Clinical Chemistry and Endocrinology, Prince of Wales Hospital, NSW Health Pathology, Sydney, NSW, Australia
| | - Graham Jones
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,SydPath, St Vincent's Hospital, Sydney, NSW, Australia
| | - Michael Legg
- Michael Legg & Associates, Wollongong, NSW, Australia.,Faculty of Engineering and Information Science, University of Wollongong, Wollongong, NSW, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, NSW, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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7
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Dahm MR, Georgiou A, Westbrook JI, Greenfield D, Horvath AR, Wakefield D, Li L, Hillman K, Bolton P, Brown A, Jones G, Herkes R, Lindeman R, Legg M, Makeham M, Moses D, Badmus D, Campbell C, Hardie RA, Li J, McCaughey E, Sezgin G, Thomas J, Wabe N. Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol. BMJ Open 2018; 8:e020235. [PMID: 29449297 PMCID: PMC5829886 DOI: 10.1136/bmjopen-2017-020235] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability; (2) harness health information technology (IT) to inform and monitor test-result management; (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems. METHODS AND ANALYSIS This convergent mixed-methods project triangulates three multistage studies at seven adult hospitals and one paediatric hospital in Australia.Study 1 adopts qualitative research approaches including semistructured interviews, focus groups and ethnographic observations to gain a better understanding of test-result communication and management practices in hospitals, and to identify patient-safety risks which require quality-improvement interventions.Study 2 analyses linked sets of routinely collected healthcare data to examine critical test-result thresholds and test-result notification processes. A controlled before-and-after study across three emergency departments will measure the impact of interventions (including the use of IT) developed to improve the safety and quality of test-result communication and management processes.Study 3 adopts a consumer-driven approach, including semistructured interviews, and the convening of consumer-reference groups and community forums. The qualitative data will identify mechanisms to enhance the role of consumers in test-management governance processes, and inform the direction of the research and the interpretation of findings. ETHICS AND DISSEMINATION Ethical approval has been granted by the South Eastern Sydney Local Health District Human Research Ethics Committee and Macquarie University. Findings will be disseminated in academic, industry and consumer journals, newsletters and conferences.
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Affiliation(s)
- Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - Andrea R Horvath
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Clinical Chemistry and Endocrinology, Prince of Wales Hospital, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Denis Wakefield
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Centre for Immunology, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ken Hillman
- The Simpson Centre for Health Services Research, SWS Clinical School, University of New South Wales, Kensington, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Patrick Bolton
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
| | - Anthony Brown
- Health Consumers New South Wales, Sydney, New South Wales, Australia
- Men's Health Information and Resource Centre, Western Sydney University, Penrith, New South Wales, Australia
| | - Graham Jones
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- SydPath, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Robert Herkes
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | | | - Michael Legg
- Michael Legg & Associates, Bulli, New South Wales, Australia
- Faculty of Engineering & Information Science, University of Wollongong, Wollongong, New South Wales, Australia
| | - Meredith Makeham
- Australian Digital Health Agency, Sydney, New South Wales, Australia
| | - Daniel Moses
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Medical Imaging Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Dauda Badmus
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Craig Campbell
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Clinical Chemistry and Endocrinology, Prince of Wales Hospital, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Rae-Anne Hardie
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Euan McCaughey
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), University of New South Wales, Kensington, New South Wales, Australia
| | - Gorkem Sezgin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Georgiou A, McCaughey EJ, Tariq A, Walter SR, Li J, Callen J, Paoloni R, Runciman WB, Westbrook JI. What is the impact of an electronic test result acknowledgement system on Emergency Department physicians’ work processes? A mixed-method pre-post observational study. Int J Med Inform 2017; 99:29-36. [DOI: 10.1016/j.ijmedinf.2016.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/03/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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Samal L, Dykes PC, Greenberg JO, Hasan O, Venkatesh AK, Volk LA, Bates DW. Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review. BMC Health Serv Res 2016; 16:143. [PMID: 27106509 PMCID: PMC4841960 DOI: 10.1186/s12913-016-1373-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/01/2016] [Indexed: 12/22/2022] Open
Abstract
Background Health information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms. We sought to determine, from a clinician perspective, how care is coordinated and to what extent HIT is involved when transitioning patients between emergency departments, acute care hospitals, skilled nursing facilities, and home health agencies in settings across the United States. Methods We performed a qualitative study with clinicians and information technology professionals from six regions of the U.S. which were chosen as national leaders in HIT. We analyzed data through a two person consensus approach, assigning responses to each of nine care coordination activities. We also conducted a literature review of MEDLINE®, CINAHL®, and Embase, analyzing results of studies that examined interventions to improve information transfer during transitions of care. Results We enrolled 29 respondents from 17 organizations and conducted six focus groups. Respondents reported how HIT is currently used for care coordination activities. HIT is currently used to monitor patients and to align systems-level resources with population needs. However, we identified multiple areas where the lack of interoperability leads to inefficient processes and missing data. Additionally, the literature review identified ten intervention studies that address information transfer, seven of which employed HIT and three of which utilized other communication methods such as telephone calls, faxed records, and nurse case management. Conclusions Significant care coordination gaps exist due to the lack of interoperability across the United States. We must design, evaluate, and incentivize the use of HIT for care coordination. We should focus on the domains where we found the largest gaps: information transfer, systems to monitor patients, tools to support patients’ self-management goals, and tools to link patients and their caregivers with community resources. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1373-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lipika Samal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Patricia C Dykes
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey O Greenberg
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.,Harvard Medical School, Boston, MA, USA
| | - Omar Hasan
- American Medical Association, Chicago, IL, USA
| | | | | | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.,Harvard Medical School, Boston, MA, USA.,Partners Healthcare System, Boston, MA, USA
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10
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O'Connor SD, Dalal AK, Sahni VA, Lacson R, Khorasani R. Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up? J Am Med Inform Assoc 2015; 23:333-8. [PMID: 26335982 DOI: 10.1093/jamia/ocv105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/01/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess whether integrating critical result management software--Alert Notification of Critical Results (ANCR)--with an electronic health record (EHR)-based results management application impacts closed-loop communication and follow-up of nonurgent, clinically significant radiology results by primary care providers (PCPs). MATERIALS AND METHODS This institutional review board-approved study was conducted at a large academic medical center. Postintervention, PCPs could acknowledge nonurgent, clinically significant ANCR-generated alerts ("alerts") within ANCR or the EHR. Primary outcome was the proportion of alerts acknowledged via EHR over a 24-month postintervention. Chart abstractions for a random sample of alerts 12 months preintervention and 24 months postintervention were reviewed, and the follow-up rate of actionable alerts (eg, performing follow-up imaging, administering antibiotics) was estimated. Pre- and postintervention rates were compared using the Fisher exact test. Postintervention follow-up rate was compared for EHR-acknowledged alerts vs ANCR. RESULTS Five thousand nine hundred and thirty-one alerts were acknowledged by 171 PCPs, with 100% acknowledgement (consistent with expected ANCR functionality). PCPs acknowledged 16% (688 of 4428) of postintervention alerts in the EHR, with the remaining in ANCR. Follow-up was documented for 85 of 90 (94%; 95% CI, 88%-98%) preintervention and 79 of 84 (94%; 95% CI, 87%-97%) postintervention alerts (P > .99). Postintervention, 11 of 14 (79%; 95% CI, 52%-92%) alerts were acknowledged via EHR and 68 of 70 (97%; 95% CI, 90%-99%) in ANCR had follow-up (P = .03). CONCLUSIONS Integrating ANCR and EHR provides an additional workflow for acknowledging nonurgent, clinically significant results without significant change in rates of closed-loop communication or follow-up of alerts.
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Affiliation(s)
- Stacy D O'Connor
- Center for Evidence Based Imaging, Brookline, Massachusetts, USA Department of Radiology Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anuj K Dalal
- Center for Evidence Based Imaging, Brookline, Massachusetts, USA Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - V Anik Sahni
- Center for Evidence Based Imaging, Brookline, Massachusetts, USA Department of Radiology Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronilda Lacson
- Center for Evidence Based Imaging, Brookline, Massachusetts, USA
| | - Ramin Khorasani
- Center for Evidence Based Imaging, Brookline, Massachusetts, USA Department of Radiology Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Kantor MA, Evans KH, Shieh L. Pending studies at hospital discharge: a pre-post analysis of an electronic medical record tool to improve communication at hospital discharge. J Gen Intern Med 2015; 30:312-8. [PMID: 25416599 PMCID: PMC4351274 DOI: 10.1007/s11606-014-3064-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/18/2014] [Accepted: 09/25/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Achieving safe transitions of care at hospital discharge requires accurate and timely communication. Both the presence of and follow-up plan for diagnostic studies that are pending at hospital discharge are expected to be accurately conveyed during these transitions, but this remains a challenge. OBJECTIVE To determine the prevalence, characteristics, and communication of studies pending at hospital discharge before and after the implementation of an electronic medical record (EMR) tool that automatically generates a list of pending studies. DESIGN Pre-post analysis. PATIENTS 260 consecutive patients discharged from inpatient general medicine services from July to August 2013. INTERVENTION Development of an EMR-based tool that automatically generates a list of studies pending at discharge. MAIN MEASURES The main outcomes were prevalence and characteristics of pending studies and communication of studies pending at hospital discharge. We also surveyed internal medicine house staff on their attitudes about communication of pending studies. KEY RESULTS Pre-intervention, 70% of patients had at least one pending study at discharge, but only 18% of these were communicated in the discharge summary. Most studies were microbiology cultures (68%), laboratory studies (16%), or microbiology serologies (10%). The majority of study results were ultimately normal (83%), but 9% were newly abnormal. Post-intervention, communication of studies pending increased to 43% (p < 0.001). CONCLUSIONS Most patients are discharged from the hospital with pending studies, but in usual practice, the presence of these studies has rarely been communicated to outpatient providers in the discharge summary. Communication significantly increased with the implementation of an EMR-based tool that automatically generated a list of pending studies from the EMR and allowed users to import this list into the discharge summary. This is the first study to our knowledge to introduce an automated EMR-based tool to communicate pending studies.
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Affiliation(s)
- Molly A Kantor
- Stanford University School of Medicine, 300 Pasteur Drive, Lane 154, Stanford, CA, 94305, USA,
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12
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Four-year impact of an alert notification system on closed-loop communication of critical test results. AJR Am J Roentgenol 2015; 203:933-8. [PMID: 25341129 DOI: 10.2214/ajr.14.13064] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE One of the patient safety goals proposed by the Joint Commission urges hospitals to develop a policy for communicating critical test results and to measure adherence to that policy. We evaluated the impact of an alert notification system on policy adherence for communicating critical imaging test results to referring providers and assessed system adoption over the first 4 years after implementation. MATERIALS AND METHODS This study was performed in a 753-bed academic medical center. The intervention, an automated alert notification system for critical results, was implemented in January 2010. The primary outcome was adherence to institutional policy for timely closed-loop communication of critical imaging results, and the secondary outcome was system adoption. Policy adherence was determined through manual review of a random sample of radiology reports from the first 4 years after the intervention (n = 37,604) compared with baseline outcomes 1 year before the intervention (n = 9430). Adoption was evaluated by quantifying the use of the system overall and the proportion of alerts that used noninterruptive communication as a percentage of all reports generated by 320 radiologists (n = 1,538,059). A statistical analysis of the trend at 6-month intervals over 4 years was performed using a chi-square trend test. RESULTS Adherence to the policy increased from 91.3% before the intervention to 95.0% after the intervention (p < 0.0001). There was a ninefold increase in the critical results communicated via the system (chi-square trend test, p < 0.0001). During the first 4 years after the intervention, 41,445 alerts (41% of the total number of alerts) used the system's noninterruptive process for communicating less urgent critical results, which was substantially unchanged over the 4 years postintervention, thus reducing unnecessary paging interruptions. CONCLUSION An automated alert notification system for communicating critical imaging results was successfully adopted and was associated with increased adherence to institutional policy for communicating critical test results and with reduced workflow interruptions.
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Georgiou A, Lymer S, Forster M, Strachan M, Graham S, Hirst G, Callen J, Westbrook JI. Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers' hospital. J Am Med Inform Assoc 2014; 21:1104-8. [PMID: 24598829 PMCID: PMC4215041 DOI: 10.1136/amiajnl-2013-002466] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/19/2014] [Accepted: 02/17/2014] [Indexed: 11/15/2022] Open
Abstract
This study describes the implementation and impact of an electronic test result acknowledgement (RA) system in the Mater Mothers' Hospital in Brisbane, Australia. The Verdi application electronically records clinicians' acknowledgement of the review of results. Hospital data (August 2011-August 2012) were extracted to measure clinicians' acknowledgement practices. There were 27,354 inpatient test results for 6855 patients. All test results were acknowledged. 60% (95% CI 59% to 61%) of laboratory and 44% (95% CI 40% to 48%) of imaging results were acknowledged within 24 h. The median time between report availability and acknowledgement was 18.1 h for laboratory and 1 day 18 h for imaging results. The median time from when a result was first viewed to its acknowledgement was 7 min for laboratory and 1 min for imaging results. The longest recorded time to acknowledgement was 38 days. Electronic RA provides a safety net to enhance test result management.
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Affiliation(s)
- Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Sharyn Lymer
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan Forster
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Michael Strachan
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Sara Graham
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Geof Hirst
- Mater Health Services, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Joanne Callen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
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Dalal AK, Roy CL, Poon EG, Williams DH, Nolido N, Yoon C, Budris J, Gandhi T, Bates DW, Schnipper JL. Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial. J Am Med Inform Assoc 2013; 21:473-80. [PMID: 24154834 DOI: 10.1136/amiajnl-2013-002030] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Physician awareness of the results of tests pending at discharge (TPADs) is poor. We developed an automated system that notifies responsible physicians of TPAD results via secure, network email. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results. METHODS We conducted a cluster-randomized controlled trial at a major hospital affiliated with an integrated healthcare delivery network in Boston, Massachusetts. Adult patients with TPADs who were discharged from inpatient general medicine and cardiology services were assigned to the intervention or usual care arm if their inpatient attending physician and primary care physician (PCP) were both randomized to the same study arm. Patients of physicians randomized to discordant study arms were excluded. We surveyed these physicians 72 h after all TPAD results were finalized. The primary outcome was awareness of TPAD results by attending physicians. Secondary outcomes included awareness of TPAD results by PCPs, awareness of actionable TPAD results, and provider satisfaction. RESULTS We analyzed data on 441 patients. We sent 441 surveys to attending physicians and 353 surveys to PCPs and received 275 and 152 responses from 83 different attending physicians and 112 different PCPs, respectively (attending physician survey response rate of 63%). Intervention attending physicians and PCPs were significantly more aware of TPAD results (76% vs 38%, adjusted/clustered OR 6.30 (95% CI 3.02 to 13.16), p<0.001; 57% vs 33%, adjusted/clustered OR 3.08 (95% CI 1.43 to 6.66), p=0.004, respectively). Intervention attending physicians tended to be more aware of actionable TPAD results (59% vs 29%, adjusted/clustered OR 4.25 (0.65, 27.85), p=0.13). One hundred and eighteen (85%) and 43 (63%) intervention attending physician and PCP survey respondents, respectively, were satisfied with this intervention. CONCLUSIONS Automated email notification represents a promising strategy for managing TPAD results, potentially mitigating an unresolved patient safety concern. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT01153451).
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Affiliation(s)
- Anuj K Dalal
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Abstract
BACKGROUND Health information technology (HIT) systems have the potential to reduce delayed, missed or incorrect diagnoses. We describe and classify the current state of diagnostic HIT and identify future research directions. METHODS A multi-pronged literature search was conducted using PubMed, Web of Science, backwards and forwards reference searches and contributions from domain experts. We included HIT systems evaluated in clinical and experimental settings as well as previous reviews, and excluded radiology computer-aided diagnosis, monitor alerts and alarms, and studies focused on disease staging and prognosis. Articles were organised within a conceptual framework of the diagnostic process and areas requiring further investigation were identified. RESULTS HIT approaches, tools and algorithms were identified and organised into 10 categories related to those assisting: (1) information gathering; (2) information organisation and display; (3) differential diagnosis generation; (4) weighing of diagnoses; (5) generation of diagnostic plan; (6) access to diagnostic reference information; (7) facilitating follow-up; (8) screening for early detection in asymptomatic patients; (9) collaborative diagnosis; and (10) facilitating diagnostic feedback to clinicians. We found many studies characterising potential interventions, but relatively few evaluating the interventions in actual clinical settings and even fewer demonstrating clinical impact. CONCLUSIONS Diagnostic HIT research is still in its early stages with few demonstrations of measurable clinical impact. Future efforts need to focus on: (1) improving methods and criteria for measurement of the diagnostic process using electronic data; (2) better usability and interfaces in electronic health records; (3) more meaningful incorporation of evidence-based diagnostic protocols within clinical workflows; and (4) systematic feedback of diagnostic performance.
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Affiliation(s)
- Robert El-Kareh
- Division of Biomedical Informatics, UCSD, , San Diego, California, USA
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Li J, Talaei-Khoei A, Seale H, Ray P, Macintyre CR. Health Care Provider Adoption of eHealth: Systematic Literature Review. Interact J Med Res 2013; 2:e7. [PMID: 23608679 PMCID: PMC3628149 DOI: 10.2196/ijmr.2468] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/04/2013] [Accepted: 03/09/2013] [Indexed: 11/13/2022] Open
Abstract
Background eHealth is an application of information and communication technologies across the whole range of functions that affect health. The benefits of eHealth (eg, improvement of health care operational efficiency and quality of patient care) have previously been documented in the literature. Health care providers (eg, medical doctors) are the key driving force in pushing eHealth initiatives. Without their acceptance and actual use, those eHealth benefits would be unlikely to be reaped. Objective To identify and synthesize influential factors to health care providers’ acceptance of various eHealth systems. Methods This systematic literature review was conducted in four steps. The first two steps facilitated the location and identification of relevant articles. The third step extracted key information from those articles including the studies’ characteristics and results. In the last step, identified factors were analyzed and grouped in accordance with the Unified Theory of Acceptance and Use of Technology (UTAUT). Results This study included 93 papers that have studied health care providers’ acceptance of eHealth. From these papers, 40 factors were identified and grouped into 7 clusters: (1) health care provider characteristics, (2) medical practice characteristics, (3) voluntariness of use, (4) performance expectancy, (5) effort expectancy, (6) social influence, and (7) facilitating or inhibiting conditions. Conclusions The grouping results demonstrated that the UTAUT model is useful for organizing the literature but has its limitations. Due to the complex contextual dynamics of health care settings, our work suggested that there would be potential to extend theories on information technology adoption, which is of great benefit to readers interested in learning more on the topic. Practically, these findings may help health care decision makers proactively introduce interventions to encourage acceptance of eHealth and may also assist health policy makers refine relevant policies to promote the eHealth innovation.
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Affiliation(s)
- Junhua Li
- Asia-Pacific ubiquitous Healthcare research Centre (APuHC), The University of New South Wales, Sydney, Australia.
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Mudano AS, Gary LC, Oliveira AL, Melton M, Wright NC, Curtis JR, Delzell E, Harrington TM, Kilgore ML, Lewis CE, Singh JA, Warriner AH, Pace WD, Saag KG. Using tablet computers compared to interactive voice response to improve subject recruitment in osteoporosis pragmatic clinical trials: feasibility, satisfaction, and sample size. Patient Prefer Adherence 2013; 7:517-23. [PMID: 23807841 PMCID: PMC3685447 DOI: 10.2147/ppa.s44551] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pragmatic clinical trials (PCTs) provide large sample sizes and enhanced generalizability to assess therapeutic effectiveness, but efficient patient enrollment procedures are a challenge, especially for community physicians. Advances in technology may improve methods of patient recruitment and screening in PCTs. Our study looked at a tablet computer versus an integrated voice response system (IVRS) for patient recruitment and screening for an osteoporosis PCT in community physician offices. MATERIALS AND METHODS We recruited women ≥ 65 years of age from community physician offices to answer screening questions for a hypothetical osteoporosis active comparator PCT using a tablet computer or IVRS. We assessed the feasibility of these technologies for patient recruitment as well as for patient, physician, and office staff satisfaction with the process. We also evaluated the implications of these novel recruitment processes in determining the number of primary care practices and screened patients needed to conduct the proposed trial. RESULTS A total of 160 women (80% of those approached) agreed to complete the osteoporosis screening questions in ten family physicians' offices. Women using the tablet computer were able to complete all screening questions consistently and showed a nonsignificant trend towards greater ease of use and willingness to spend more time in their physician's office compared to those using IVRS. Using the proportion of women found to be eligible in this study (almost 20%) and other eligibility scenarios, we determined that between 240 and 670 community physician offices would be needed to recruit ample patients for our hypothetical study. CONCLUSION We found good satisfaction and feasibility with a tablet computer interface for the recruitment and screening of patients for a hypothetical osteoporosis PCT in community office settings. In addition, we used this experience to estimate the number of research sites needed for such a study.
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Affiliation(s)
- Amy S Mudano
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Lisa C Gary
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Ana L Oliveira
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Mary Melton
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Nicole C Wright
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Jeffrey R Curtis
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Elizabeth Delzell
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - T Michael Harrington
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Meredith L Kilgore
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Cora Elizabeth Lewis
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Jasvinder A Singh
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Amy H Warriner
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
| | - Wilson D Pace
- Distributed Ambulatory Research in Therapeutics Network (DARTNet), American Academy of Family Physicians (AAFP), University of Colorado, Denver, CO, USA
| | - Kenneth G Saag
- Center for Education and Research on Therapeutics (CERTs)
- Center for Outcomes Effectiveness Research and Education (COERE), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Center for Clinical and Translational Sciences (CCTS), (University of Alabama at Birmingham, Birmingham, AL, USA)
- Correspondence: Kenneth G Saag, The University of Alabama at Birmingham, 820 Faculty Office Tower, 510 20th Street South, Birmingham, AL, USA 35294, Tel +1 205 996 9784, Fax +1 205 975 6859, Email
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El-Kareh R, Roy C, Williams DH, Poon EG. Impact of automated alerts on follow-up of post-discharge microbiology results: a cluster randomized controlled trial. J Gen Intern Med 2012; 27:1243-50. [PMID: 22278302 PMCID: PMC3445692 DOI: 10.1007/s11606-012-1986-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 12/16/2011] [Accepted: 12/27/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Failure to follow up microbiology results pending at the time of hospital discharge can delay diagnosis and treatment of important infections, harm patients, and increase the risk of litigation. Current systems to track pending tests are often inadequate. OBJECTIVE To design, implement, and evaluate an automated system to improve follow-up of microbiology results that return after hospitalized patients are discharged. DESIGN Cluster randomized controlled trial. SUBJECTS Inpatient and outpatient physicians caring for adult patients hospitalized at a large academic hospital from February 2009 to June 2010 with positive and untreated or undertreated blood, urine, sputum, or cerebral spinal fluid cultures returning post-discharge. INTERVENTION An automated e-mail-based system alerting inpatient and outpatient physicians to positive post-discharge culture results not adequately treated with an antibiotic at the time of discharge. MAIN MEASURES Our primary outcome was documented follow-up of results within 3 days. Secondary outcomes included physician awareness and assessment of result urgency, impact on clinical assessments and plans, and preferred alerting scenarios. KEY RESULTS We evaluated the follow-up of 157 post-discharge microbiology results from patients of 121 physicians. We found documented follow-up in 27/97 (28%) results in the intervention group and 8/60 (13%) in the control group [aOR 3.2, (95% CI 1.3-8.4); p=0.01]. Of all inpatient physician respondents, 32/82 (39%) were previously aware of the results, 45/77 (58%) felt the results changed their assessments and plans, 43/77 (56%) felt the results required urgent action, and 67/70 (96%) preferred alerts for current or broader scenarios. CONCLUSION Our alerting system improved the proportion of important post-discharge microbiology results with documented follow-up, though the proportion remained low. The alerts were well received and may be expanded in the future.
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Affiliation(s)
- Robert El-Kareh
- Division of Biomedical Informatics, University of California San Diego, 9500 Gilman Dr., no. 0505, La Jolla, San Diego, CA 92093-0505, USA,
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Dalal AK, Schnipper JL, Poon EG, Williams DH, Rossi-Roh K, Macleay A, Liang CL, Nolido N, Budris J, Bates DW, Roy CL. Design and implementation of an automated email notification system for results of tests pending at discharge. J Am Med Inform Assoc 2012; 19:523-8. [PMID: 22268214 DOI: 10.1136/amiajnl-2011-000615] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Physicians are often unaware of the results of tests pending at discharge (TPADs). The authors designed and implemented an automated system to notify the responsible inpatient physician of the finalized results of TPADs using secure, network email. The system coordinates a series of electronic events triggered by the discharge time stamp and sends an email to the identified discharging attending physician once finalized results are available. A carbon copy is sent to the primary care physicians in order to facilitate communication and the subsequent transfer of responsibility. Logic was incorporated to suppress selected tests and to limit notification volume. The system was activated for patients with TPADs discharged by randomly selected inpatient-attending physicians during a 6-month pilot. They received approximately 1.6 email notifications per discharged patient with TPADs. Eighty-four per cent of inpatient-attending physicians receiving automated email notifications stated that they were satisfied with the system in a brief survey (59% survey response rate). Automated email notification is a useful strategy for managing results of TPADs.
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Affiliation(s)
- Anuj K Dalal
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Cadwallader J, Asirwa C, Li X, Kesterson J, Tierney WM, Were MC. Using computerized provider order entry to enforce documentation of tests with pending results at hospital discharge. Appl Clin Inform 2012; 3:154-63. [PMID: 23616906 DOI: 10.4338/aci-2012-01-ra-0001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/21/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Small numbers of tests with pending results are documented in hospital discharge summaries leading to breakdown in communication and medical errors due to inadequate followup. OBJECTIVE Evaluate effect of using a computerized provider order entry (CPOE) system to enforce documentation of tests with pending results into hospital discharge summaries. METHODS We assessed the percent of all tests with pending results and those with actionable results that were documented before (n = 182 discharges) and after (n = 203 discharges) implementing the CPOE-enforcement tool. We also surveyed providers (n = 52) about the enforcement functionality. RESULTS Documentation of all tests with pending results improved from 12% (87/701 tests) before to 22% (178/812 tests) (p = 0.02) after implementation. Documentation of tests with eventual actionable results increased from 0% (0/24) to 50% (14/28)(p<0.001). Survey respondents felt the intervention improved quality of summaries, provider communication, and was not time-consuming. CONCLUSIONS A CPOE tool enforcing documentation of tests with pending results into discharge summaries significantly increased documentation rates, especially of actionable tests. However, gaps in documentation still exist.
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Wachter RM, Auerbach AD. Filling the black hole of hospital discharge (editorial in response to article by Walz et al.,J Gen Intern Med 2011). J Gen Intern Med 2011; 26:354-5. [PMID: 21327528 PMCID: PMC3055976 DOI: 10.1007/s11606-011-1643-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert M. Wachter
- Department of Medicine, University of California, San Francisco, Room M-994, 505 Parnassus Avenue, San Francisco, CA 94143-0120 USA
| | - Andrew D. Auerbach
- Department of Medicine, University of California, San Francisco, Room M-994, 505 Parnassus Avenue, San Francisco, CA 94143-0120 USA
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