Background: Emergency department (ED) care decisions often hinge 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 based on that result. Push notifications to physician smartphones have demonstrated improvement in this lag time in chest pain patients, but have not been studied in other ED patients. We implemented a system by which ED providers can subscribe to electronic alerts when test results are available for review via a smartphone or smartwatch push notification, and hypothesized that this would reduce the time to make clinical decisions.
Methods: This was a retrospective, multicenter, observational study in three emergency departments of an urban health system. We assessed push notification impact on time to disposition or time to follow-up order in six clinical scenarios of interest: chest x-ray (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 D-dimer to computed tomography pulmonary angiography (CTPA) order. All adult ED patients during a one-year period of push notification availability were included in the study. The primary outcome was median time from result availability to disposition order or defined follow-up order. Median times with interquartile ranges were determined in each scenario and the Mann Whitney (Wilcoxon) test for unpaired data was used to determine statistical significance.
Results: During the study period there were 6,115 push notifications from 4,183 eligible ED encounters (2.7% of all ED encounters). All six scenarios studied were associated with a decrease in median time from test result availability to patient disposition, or from test result availability to follow-up order, when push notifications were employed: CXR to disposition (24 minutes, p<0.01), BMP to disposition (12 minutes, p<0.01), UA to disposition (50 minutes, p<0.01), RPP to disposition (43 minutes, p<0.01), D-dimer to CTPA (8 minutes, p<0.01), Hb to blood transfusion (19 minutes, p=0.73).
Conclusion: Implementation of a push notification system for test result availability in the ED was associated with a decrease in lag time between test result availability and physician decision-making.