Background: Emergency Departments (EDs) measure throughput metrics for quality improvement. A predominant factor in those metrics is time awaiting patient results. Results for blood tests, imaging, etc, serve as a branch point in medical decision making. The time it takes for a test to result, the provider to acknowledge it, and the subsequent incorporation of the result into medical decision making are all critical. To streamline this process, one healthcare system in Massachusetts created a system allowing providers to opt-in to the automated notification of certain results via alphanumeric pages. Our study aimed to evaluate the impact of this notification system on the time between lab results and subsequent provider actions related to pulmonary embolisms.
Methods: Administrative data were collected from the electronic medical record for all patients seen in the EDs of two academic hospitals in Boston, MA between 04/01/2016 and 03/31/2018.Encounters were selected based on the ordering of a d-dimer and chest imaging (CT or ventilation/perfusion scans). A two-sample t-test analyzed the time between a d-dimer result and subsequent pulmonary imaging among encounters in which the notification system was and was not activated.
Results: There were 266,856 patient encounters in the EDs during the study period with 8,482 d-dimers results. The notification system was activated for 122 encounters. On average, during encounters in which automated notifications were sent, chest imaging was ordered 27.5 minutes after d-dimer result, while among encounters without automated notifications, imaging was ordered after 33.1 minutes. Maximum lag time was 159 minutes with automated notifications compared to 236 minutes without notifications. The difference in time to imaging ordering after d-dimer result was not statistically significant, t(1313) = 0.80, p = 0.42, 95%CI: -8.01 to 19.1.
Conclusions: Though not producing a statistically significant difference in the time between d-dimer result and imaging for suspicion of pulmonary emboli, the automated notification system may be achieving its goal in other clinical scenarios. The fact that the maximum time to ordering was 67% shorter suggests that it may be making clinically significant differences despite statistical insignificance. Further investigation is warranted into the use and impact of this notification system.