Effects of Passive Lab Notification Features on Emergency Department Process Times
Creators: name: Peterson, Gary Lee
Publisher: name: University of Utah
Year: 2014

description: Annually, 46 million patients, or 37% of patients seen in the emergency department (ED), receive laboratory testing in the U.S.; thus, making efficient lab order and result management critical to improving ED throughput, clinical efficacy, and safety. In order to manage labs and other processes, electronic emergency department tracking systems (EDTS) or electronic whiteboards have evolved features that support clinical, operational, and administrative needs. EDTSs have often augmented manual data entry with interfaces and/or integration with other systems such as registration, laboratory, radiology, and clinical information systems (CIS). Although the intent of these features is to improve operational efficiency and patient care, the operational and clinical effects of specific integration, such as EDTS /CIS context sharing with lab result notifications, have received only cursory study. In this setting, EDTS/CIS context sharing automatically passes all necessary user, patient, and application parameters between the two systems in order to open the CIS lab module for a selected patient when the user is notified in the EDTS that laboratory test results for that patient are available for review. Therefore, context sharing eliminates the need for users to manually open the CIS, log-on, search for and select the correct patient, and navigate to the lab viewing module in order to specify the context parameters needed to view a patient's lab results. This study evaluates the effects of adding EDTS/CIS context sharing to an EDTS with lab notifications on ED process times. These effects were measured utilizing a pre-/post-intervention design for all ED encounters where specific common labs were resulted. A method of analyzing CIS audit logs in combination with EDTS and laboratory information system timestamps was implemented to measure patient management processes for quality improvement. After adding context sharing to lab notification features, the median interval between the availability of lab results and review of those results by the ordering provider decreased from 22.7 min., by 25% or 5.7 min. (p-value &lt; 0.001), to 17.0 min. However, median time from resulting of labs to patient discharge were essentially unchanged, decreasing from 106.6 min. to 105.0 min. (p-value = 0.080). The proportion of lab results reviewed by physicians in the CIS integrated with the EDTS increased from 66% to 86% after the intervention (p-value &lt; 0.001). EDTS/CIS context sharing and passive lab notification features improved the timeliness and completion of lab result review in the CIS and increased system adoption in this setting. However, these improvements in the time intervals to review of lab results in the CIS did not result in an operationally or statistically significant improvement in time to discharge after the availability of results. Combining EDTS process times and CIS audit log timestamps is a feasible and efficient way to gain additional information about workflow processes for ED quality improvement and may augment process measures captured in the EDTS with less reliance on costly manual chart abstraction or direct observation.