Clinical trial NCT01153451: An Automatic Notification System for Test Results Finalized After Discharge
Official title: An Automatic Notification System for Test Results Finalized After Discharge
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Test Result Management
Keywords: Pending tests
Discharge
Awareness
Care transitions
Lead sponsor: Brigham and Women's Hospital
Sponsor class: OTHER
First posted: 2010-06-30
Enrollment: 441
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Specific Aims: (Study #1, funded by AHRQ, completed May 2011)

1. To create an automatic notification system to prompt physicians of test results finalized after discharge.
2. To evaluate the impact of this system on physician awareness of test results finalized after discharge.

Hypothesis: Automatic email notification will improve physician awareness of test results finalized after discharge compared to usual care.

Specific Aims: (Study #2, funded by CRICO, completed July 2012)

1. To identify a cohort of discharged patients with potentially actionable results of tests pending at discharge (TPAD).
2. To determine if automated email notification of the finalized results of potentially actionable TPADs affects the rate of post-discharge actions taken as documented in the electronic medical record (EMR).

Hypothesis: Automated email notification of the finalized results of potentially actionable TPADs increases the rate of actions taken post-discharge.

Detailed description: Failure to follow up on abnormal test results is a critical problem and is more likely to occur in the case of tests that are performed in the hospital but whose results are not available or not finalized until after discharge (i.e., pending test results). Responsible inpatient and ambulatory providers may not be aware of these test results. In a prior study, Roy et al. determined that 41% of patients were discharged before all laboratory, microbiology, and radiology test results were finalized (31% were collectively hematology, chemistry, and pathology tests, 27% were radiology studies, and 42% were microbiology results). Of these results, 9.4% were considered potentially actionable by independent physician review and could have altered the post-discharge patient care plan. Physicians were only aware of 38% of these test results. Failure to follow-up on these test results can lead to delays in diagnosis, missed treatment opportunities, redundant ordering of tests, and subsequent patient harm. In a hospital the size of Brigham and Women's Hospital (BWH) with 44,000 annual admissions, physicians would be unaware of almost 2000 actionable test results per year. Automated systems can mitigate this problem by ensuring prompt notification of relevant test results finalized after discharge to responsible inpatient and ambulatory providers. Using internal BWH funding, we have developed an automated email notification system to facilitate management of tests pending at discharge (TPADs).

In study 1 (funded by AHRQ), we will prospectively evaluate the impact of this intervention on physician awareness of TPAD results. In study 2 (funded by CRICO), we will perform a chart review to determine the impact of the intervention on downstream actions taken by physicians and acknowledgment of TPAD results as documented in the electronic medical record.

Eligibility criteria: Inclusion Criteria:

* Any patient discharged from selected services at BWH whose inpatient attending and primary care provider are in the same arm of the study.

Exclusion Criteria:

* Any patient discharged from selected services at BWH whose inpatient attending and primary care provider are in discordant arms of the study.

Primary outcomes:
measure: Percent of Inpatient Providers Aware of Finalized Results of Tests Pending at Discharge (Study 1)
timeFrame: 72 hours after notification, October 2010 thru May 2011
Secondary outcomes:
measure: Percent of Ambulatory Providers Aware of Finalized Results of Tests Pending at Discharge (Study 1)
timeFrame: 72 hours after notification, October 2010 thru May 2011
measure: Percent of Providers Aware of Actionable Test Results (Study 1)
timeFrame: 72 hours after notification, October 2010 thru May 2011
measure: Provider Satisfaction (Study 1)
timeFrame: 72 hours after notification, October 2010 thru May 2011
Other outcomes:
measure: Proportion of potentially actionable TPAD results with documented action(s) taken in the intervention versus control arms. (Primary Outcome, Study 2)
timeFrame: Retrospective chart data abstraction for patients discharged from July 2011 through July 2012
measure: Proportion of potentially actionable TPAD results with documented acknowledgement in the intervention versus control arms. (Secondary Outcome, Study 2)
timeFrame: Retrospective chart data abstraction for patients discharged from July 2011 through July 2012
Locations:
city: Boston
country: United States
facility: Brigham and Women's Hospital
state: Massachusetts
Study officials:
affiliation: Brigham and Women's Hospital
name: Anuj K Dalal, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Dalal AK, Schaffer A, Gershanik EF, Papanna R, Eibensteiner K, Nolido NV, Yoon CS, Williams D, Lipsitz SR, Roy CL, Schnipper JL. The Impact of Automated Notification on Follow-up of Actionable Tests Pending at Discharge: a Cluster-Randomized Controlled Trial. J Gen Intern Med. 2018 Jul;33(7):1043-1051. doi: 10.1007/s11606-018-4393-y. Epub 2018 Mar 12.
citation: 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. 2014 May-Jun;21(3):473-80. doi: 10.1136/amiajnl-2013-002030. Epub 2013 Oct 23.