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Dutta S, Dunham L, McEvoy DS, Cash RE, Meeker MA, White BA. Result Push Notifications Improve Time to Emergency Department Disposition: A Pragmatic Observational Study. Ann Emerg Med 2024:S0196-0644(24)00404-9. [PMID: 39320277 DOI: 10.1016/j.annemergmed.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 09/26/2024]
Abstract
STUDY OBJECTIVE Emergency department (ED) crowding has multiple causative factors, including delayed patient throughput. Patient care efficiency may be improved by addressing delays in decisionmaking following diagnostic testing results. We examined the influence of sending subscribed result push notifications to ED clinicians' smartphones on reducing the time to disposition decision. RESULTS All ED patient visits between October 2022 and October 2023 with a laboratory or imaging result during the ED visit and a disposition within 6 hours of the last result were included. We identified whether the last resulted study before the ED disposition decision had a subscribed push notification by the clinician who dispositioned the patient. The primary outcome was the time between the last study result and the first disposition decision. Generalized estimating equation analysis was used to control for variables including patient demographics, clinical factors, and discharging clinician. RESULTS The final study population included 237,872 encounters. The median patient age was 50 years, and 55.6% of patients were women. During the study period, 27.1% of clinicians used push notifications at least once. Of unique orders, 1.5% had a subscribed result push notification, including 0.9% of laboratory orders and 4.7% of imaging orders. The time between last result to disposition decision was 18 minutes (95% confidence interval [CI] 15 to 21) faster when a push notification was requested. CONCLUSION Elective push notification of test results was associated with reduced time between the last laboratory or imaging result and ED disposition decision. Further study is needed to determine its effect on overall ED throughput.
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Affiliation(s)
- Sayon Dutta
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Mass General Brigham Digital, Boston, MA.
| | | | | | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Melissa A Meeker
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Benjamin A White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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Peacock WF, Januzzi JL, de Theije F, Briseno T, Headden G, Birkhahn R, Allen BR, Mahler SA. Methods of the PivotaL triAl of the Atellica VTLi point of care emergencY dePartment high sensitivity troponin evalUationS. Clin Biochem 2023; 121-122:110679. [PMID: 37884085 DOI: 10.1016/j.clinbiochem.2023.110679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The Atellica® VTLi point-of-care (POC) High Sensitivity Cardiac Troponin-I (hs-cTnI) assay is intended for use as an aid in the diagnosis of myocardial infarction (MI). Our primary objective is to assess its diagnostic performance in patients presenting with suspected acute coronary syndrome (ACS). METHODS This prospective observational study will enrol ∼1500 patients at ∼20 U.S. Emergency Departments. After informed consent, adults (>21 years of age) with suspected ACS, and no prior enrollment in this study, will provide a fingerstick and venous blood sample within 2 h of ED presentation, >2 to ≤4 h, and >4 to ≤9 h (max. blood draw = 60 mL). HEART and EDACS scores will be prospectively documented. Patients without the first blood draw may be enrolled if the second draw was obtained. Capillary and venous whole blood will undergo Atellica VTLi assay testing, with remaining venous sample processed to plasma and run. All results will be blinded to the clinical care team. Site operators will undergo a 3-day familiarization period. Quality control testing will be performed daily. At 30 ± 3 days, patient mortality status, major adverse cardiac events, and rehospitalizations will be determined. A clinical endpoint adjudication committee, blinded to hs-cTnI VTLi result, will define the final diagnosis. Sensitivity, specificity, and predictive values will describe the assay performance. RESULTS We expect study completion within 114 weeks of enrollment of the first patient. CONCLUSIONS It is anticipated that the Atellica VTLi hs-cTnI assay validation study will define a performance equivalent to lab-based hs-cTnI, with results within ∼8 min at the point of care.
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Affiliation(s)
| | | | - Femke de Theije
- Siemens Healthineers Headquarters, Siemens Healthcare GmbH, Henkestr. 127, 91052 Erlangen, Germany
| | - Taylor Briseno
- Siemens Healthineers Headquarters, Siemens Healthcare GmbH, Henkestr. 127, 91052 Erlangen, Germany
| | - Gary Headden
- Medical University of South Carolina, United States
| | | | | | - Simon A Mahler
- Wake Forest University School of Medicine, United States
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3
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Adhyaru BB, Hilburn G, Oberg M, Mann K, Wu D. Push notifications for critical labs results: a pilot study in the intensive care unit (ICU). JAMIA Open 2023; 6:ooad058. [PMID: 37600076 PMCID: PMC10432354 DOI: 10.1093/jamiaopen/ooad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/13/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
Objective We developed a push notification allowing for an electronic acknowledgment of critical lab results to providers in the intensive care unit. Materials and Methods This project was conducted over a 3-month period at a large academic safety net hospital. A push notification and acknowledgment system were created to comply with the existing critical results notification requirements. We monitored the number of acknowledged results, time to acknowledgment, and lab type. Results Prior to the push notification, lab services paged the provider. This resulted in many critical lab results relayed to the clinician beyond the expected 10-minute window. With the push notification workflow, we found that, during the 3-month period, 82, or 5.8%, of the 1414 results were acknowledged. This represented 82 less pages/calls lab services had to make. Discussion The push notification alert was easy to use and there was quicker results notification when acknowledged. There were limitations due to hand-offs for clinicians and some were not familiar with the mobile technology and the electronic acknowledgment. Conclusions Although the acknowledgment rate was low, every electronic acknowledgment saved lab service technicians an average of 10 minutes compared to the existing workflow. As familiarity with the technology and workflow increases, this novel form of communication has the potential to have significant cost savings for lab services, in addition to efficiency gains for lab, clinicians, and more timely care. The integration of health information technology and push notification of critical labs should be the focus of investigation for further future research.
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Affiliation(s)
- Bhavin B Adhyaru
- Department of Medicine, Emory University School of Medicine, Grady Health System, Atlanta, Georgia, USA
| | | | | | - Karen Mann
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Grady Health System, Atlanta, Georgia, USA
| | - Daniel Wu
- Department of Emergency Medicine, Emory University School of Medicine, Grady Health System, Atlanta, Georgia, USA
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Yip M, Ackery A, Jamieson T, Mehta S. The Priorities of End Users of Emergency Department Electronic Health Records: Modified Delphi Study. JMIR Hum Factors 2023; 10:e43103. [PMID: 36897633 DOI: 10.2196/43103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/16/2023] [Accepted: 02/11/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The needs of the emergency department (ED) pose unique challenges to modern electronic health record (EHR) systems. A diverse case load of high-acuity, high-complexity presentations, and ambulatory patients, all requiring multiple transitions of care, creates a rich environment through which to critically examine EHRs. OBJECTIVE This investigation aims to capture and analyze the perspective of end users of EHR about the strengths, limitations, and future priorities for EHR in the setting of the ED. METHODS In the first phase of this investigation, a literature search was conducted to identify 5 key usage categories of ED EHRs. Using key usage categories in the first phase, a modified Delphi study was conducted with a group of 12 panelists with expertise in both emergency medicine and health informatics. Across 3 rounds of surveys, panelists generated and refined a list of strengths, limitations, and key priorities. RESULTS The findings from this investigation highlighted the preference of panelists for features maximizing functionality of basic clinical features relative to features of disruptive innovation. CONCLUSIONS By capturing the perspectives of end users in the ED, this investigation highlights areas for the improvement or development of future EHRs in acute care settings.
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Affiliation(s)
- Matthew Yip
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Alun Ackery
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Shaun Mehta
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, North York General Hospital, North York, ON, Canada
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5
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Slovis BH, Vervilles WJK, Vawdrey DK, Swartz JL, Winans C, Kairys JC, Riggio JM. Providers Electing to Receive Electronic Result Notifications: Demographics and Motivation. Appl Clin Inform 2022; 13:681-691. [PMID: 35830863 DOI: 10.1055/s-0042-1751092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Automated electronic result notifications can alert health care providers of important clinical results. In contrast to historical notification systems, which were predominantly focused on critical laboratory abnormalities and often not very customizable, modern electronic health records provide capabilities for subscription-based electronic notification. This capability has not been well studied. OBJECTIVES The purpose of this study was to develop an understanding of when and how a provider decides to use a subscription-based electronic notification. Better appreciation for the factors that contribute to selecting such notifications could aid in improving the functionality of these tools. METHODS We performed an 8-month quantitative assessment of 3,291 notifications and a qualitative survey assessment of 73 providers who utilized an elective notification tool in our electronic health record. RESULTS We found that most notifications were requested by attending physicians (∼60%) and from internal medicine specialty (∼25%). Most providers requested only a few notifications while a small minority (nearly 5%) requested 10 or more in the study period. The majority (nearly 30%) of requests were for chemistry laboratories. Survey respondents reported using the tool predominantly for important or time-sensitive laboratories. Overall opinions of the tool were positive (median = 7 out of 10, 95% confidence interval: 6-9), with 40% of eligible respondents reporting the tool improved quality of care. Reported examples included time to result review, monitoring of heparin drips, and reviewing pathology results. CONCLUSION Developing an understanding for when and how providers decide to be notified of clinical results can help aid in the design and improvement of clinical tools, such as improved elective notifications. These tools may lead to reduced time to result review which could in turn improve clinical care quality.
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Affiliation(s)
- Benjamin H Slovis
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.,Office of Clinical Informatics, Jefferson Health, Philadelphia, Pennsylvania, United States
| | - William J K Vervilles
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - David K Vawdrey
- Office of the Chief Data and Informatics Officer, Geisinger Health, Danville, Pennsylvania, United States
| | - Jordan L Swartz
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, New York, United States
| | - Catherine Winans
- Information Services and Technology, Jefferson Health, Philadelphia, Pennsylvania, United States
| | - John C Kairys
- Office of Clinical Informatics, Jefferson Health, Philadelphia, Pennsylvania, United States.,Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Jeffrey M Riggio
- Office of Clinical Informatics, Jefferson Health, Philadelphia, Pennsylvania, United States.,Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial. J Pers Med 2022; 12:jpm12030428. [PMID: 35330427 PMCID: PMC8948631 DOI: 10.3390/jpm12030428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023] Open
Abstract
For maintaining collaboration and coordination among emergency department (ED) caregivers, it is essential to effectively share patient-centered information. Indirect activities on patients, such as searching for laboratory results and sharing information with scattered colleagues, waste resources to the detriment of patients and staff. Therefore, we conducted a pilot study to evaluate the initial efficacy of a mobile app to facilitate rapid mobile access to central laboratory results and remote interprofessional communication. A total of 10 ED residents and registered nurses were randomized regarding the use of the app versus conventional methods during semi-simulated scenarios in a pediatric ED (PED). The primary outcome was the elapsed time in minutes in each group from the availability of laboratory results to their consideration by participants. The secondary outcome was the elapsed time to find a colleague upon request. Time to consider laboratory results was significantly reduced from 23 min (IQR 10.5–49.0) to 1 min (IQR 0–5.0) with the use of the app compared to conventional methods (92.2% reduction in mean times, p = 0.0079). Time to find a colleague was reduced from 24 min to 1 min (i.e., 93.0% reduction). Dedicated mobile apps have the potential to improve information sharing and remote communication in emergency care.
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7
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Lee JS, Bhandari T, Simard R, Emond M, Topping C, Woo M, Perry J, Eagles D, McRae AD, Lang E, Wong C, Sivilotti M, Newbigging J, Borgundvaag B, McLeod SL, Melady D, Chernoff L, Kiss A, Chenkin J. Point-of-care ultrasound-guided regional anaesthesia in older ED patients with hip fractures: a study to test the feasibility of a training programme and time needed to complete nerve blocks by ED physicians after training. BMJ Open 2021; 11:e047113. [PMID: 34226222 PMCID: PMC8258568 DOI: 10.1136/bmjopen-2020-047113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Point-of-care ultrasound-guided regional anaesthesia (POCUS-GRA) provides safe, rapid analgesia for older people with hip fractures but is rarely performed in the emergency department (ED). Self-perceived inadequate training and time to perform POCUS-GRA are the two most important barriers. Our objective is to assess the feasibility of a proposed multicentre, stepped-wedge cluster randomised clinical trial (RCT) to assess the impact of a knowledge-to-practice (KTP) intervention on delirium. DESIGN Open-label feasibility study. SETTING An academic tertiary care Canadian ED (annual visits 60 000). PARTICIPANTS Emergency physicians working at least one ED shift per week, excluding those already performing POCUS-GRA more than four times per year. INTERVENTION A KTP intervention, including 2-hour structured training sessions with procedure bundle and email reminders. PRIMARY AND SECONDARY OUTCOME MEASURES The primary feasibility outcome is the proportion of eligible physicians that completed training and subsequently performed POCUS-GRA. Secondary outcome is the time needed to complete POCUS-GRA. We also test the feasibility of the enrolment, consent and randomisation processes for the future stepped-wedge cluster RCT (NCT02892968). RESULTS Of 36 emergency physicians, 4 (12%) were excluded or declined participation. All remaining 32 emergency physicians completed training and 31 subsequently treated at least one eligible patient. Collectively, 27/31 (87.1%) performed 102 POCUS-GRA blocks (range 1-20 blocks per physician). The median (IQR) time to perform blocks was 15 (10-20) min, and reduction in pain was 6/10 (3-7) following POCUS-GRA. There were no reported complications. CONCLUSION Our KTP intervention, consent process and randomisation were feasible. The time to perform POCUS-GRA rarely exceeded 30 min, Our findings reinforce the existing data on the safety and effectiveness of POCUS-GRA, mitigate perceived barriers to more widespread adoption and demonstrate the feasibility of trialling this intervention for the proposed stepped-wedge cluster RCT. TRIAL REGISTRATION NUMBER Clinicaltrials.gov #02892968.
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Affiliation(s)
- Jacques Simon Lee
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tina Bhandari
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert Simard
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marcel Emond
- Axe Santé des populations et pratiques optimales en santé, Universite Laval, Quebec, Québec, Canada
- Departément de medécine d'urgence, Universite Laval, Quebec, Québec, Canada
| | - Claude Topping
- Axe Santé des populations et pratiques optimales en santé, Universite Laval, Quebec, Québec, Canada
- Department of Family and Emergency Medicine, Universite Laval, Quebec, Québec, Canada
| | - Michael Woo
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jeffrey Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew D McRae
- Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Charles Wong
- Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marco Sivilotti
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Joseph Newbigging
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald Melady
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lan Chernoff
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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8
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Schmuelling L, Franzeck FC, Nickel CH, Mansella G, Bingisser R, Schmidt N, Stieltjes B, Bremerich J, Sauter AW, Weikert T, Sommer G. Deep learning-based automated detection of pulmonary embolism on CT pulmonary angiograms: No significant effects on report communication times and patient turnaround in the emergency department nine months after technical implementation. Eur J Radiol 2021; 141:109816. [PMID: 34157638 DOI: 10.1016/j.ejrad.2021.109816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Rapid communication of CT exams positive for pulmonary embolism (PE) is crucial for timely initiation of anticoagulation and patient outcome. It is unknown if deep learning automated detection of PE on CT Pulmonary Angiograms (CTPA) in combination with worklist prioritization and an electronic notification system (ENS) can improve communication times and patient turnaround in the Emergency Department (ED). METHODS In 01/2019, an ENS allowing direct communication between radiology and ED was installed. Starting in 10/2019, CTPAs were processed by a deep learning (DL)-powered algorithm for detection of PE. CTPAs acquired between 04/2018 and 06/2020 (n = 1808) were analysed. To assess the impact of the ENS and the DL-algorithm, radiology report reading times (RRT), radiology report communication time (RCT), time to anticoagulation (TTA), and patient turnaround times (TAT) in the ED were compared for three consecutive time periods. Performance measures of the algorithm were calculated on a per exam level (sensitivity, specificity, PPV, NPV, F1-score), with written reports and exam review as ground truth. RESULTS Sensitivity of the algorithm was 79.6 % (95 %CI:70.8-87.2%), specificity 95.0 % (95 %CI:92.0-97.1%), PPV 82.2 % (95 %CI:73.9-88.3), and NPV 94.1 % (95 %CI:91.4-96 %). There was no statistically significant reduction of any of the observed times (RRT, RCT, TTA, TAT). CONCLUSION DL-assisted detection of PE in CTPAs and ENS-assisted communication of results to referring physicians technically work. However, the mere clinical introduction of these tools, even if they exhibit a good performance, is not sufficient to achieve significant effects on clinical performance measures.
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Affiliation(s)
- Lena Schmuelling
- Department of Radiology, University Hospital Basel, University of Basel, Switzerland.
| | - Fabian C Franzeck
- Department of Research and Analytic Services, University Hospital Basel, Switzerland.
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Switzerland.
| | - Gregory Mansella
- Emergency Department, University Hospital Basel, University of Basel, Switzerland.
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Switzerland.
| | - Noemi Schmidt
- Department of Radiology, University Hospital Basel, University of Basel, Switzerland.
| | - Bram Stieltjes
- Department of Radiology, University Hospital Basel, University of Basel, Switzerland; Department of Research and Analytic Services, University Hospital Basel, Switzerland.
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, Switzerland.
| | - Alexander W Sauter
- Department of Radiology, University Hospital Basel, University of Basel, Switzerland; Department of Research and Analytic Services, University Hospital Basel, Switzerland.
| | - Thomas Weikert
- Department of Radiology, University Hospital Basel, University of Basel, Switzerland; Department of Research and Analytic Services, University Hospital Basel, Switzerland.
| | - Gregor Sommer
- Department of Radiology, University Hospital Basel, University of Basel, Switzerland.
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Abstract
Information management in the emergency department (ED) is a challenge for all providers. The volume of information required to care for each patient and to keep the ED functioning is immense. It must be managed through varying means of communication and in connection with ED information systems. Management of information in the ED is imperfect; different modes and methods of identification, interpretation, action, and communication can be beneficial or harmful to providers, patients, and departmental flow. This article reviews the state of information management in the ED and proposes recommendations to improve the management of information in the future.
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Affiliation(s)
- Evan L Leventhal
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, USA.
| | - Kraftin E Schreyer
- Department of Emergency Medicine, Temple University Hospital, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
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10
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Boillat T, Siebert JN, Alduaij N, Ehrler F. GOFlow: Smartwatch app to deliver laboratory results in emergency departments - A feasibility study. Int J Med Inform 2019; 134:104034. [PMID: 31790858 DOI: 10.1016/j.ijmedinf.2019.104034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Information Technology (IT) plays a critical role in supporting emergency physicians' (EPs) routines. Pagers, personal computers, and smartphones offer fast access to patient data, such as laboratory results. However, due to the inherent features of specimen processing and laboratory instruments, the turnaround time from test ordering to availability of results can be long. Lack of follow-up of abnormal results can lead to missed information that could impact patient care and safety. Despite the increasing use of ubiquitous technologies, a third of physicians remains devoid of reliable methods for ensuring that results have been received. In this feasibility study, we report the potential of using a smartwatch to deliver laboratory results to EPs at the point-of-care and to support efficiency in emergency care. Unlike mobile devices that are increasingly used by EPs, smartwatches are always accessible, even during hands-on procedures. METHOD Two EPs and four experts in human-computer interaction designed the smartwatch application following the Design Science Research Methodology (DSRM). The application was then evaluated in a pediatric emergency department through semi-simulated scenarios by eleven EPs. The primary outcome was to measure both the app perceived usability and satisfaction scores by the aim of the System Usability Scale (SUS), and the perceived usefulness and intention of its use by the aim of the Unified Theory of Acceptance and Use of Technology (UTAUT) scale. Secondary outcomes were to assess the application's efficiency by measuring the delay between the reception of the notification and 1) the access to its details and 2) the visit to the patient. Finally, open questions about the positive and negative aspects of the prototype as well as potential improvements were asked and evaluated qualitatively. RESULTS The prototype obtained a score of 81.4 out of 100 (good) on the SUS and a score of 5.96 out of 7 on the UTAUT scale. EPs using the smartwatch visited patients within 30 seconds receiving the laboratory results. CONCLUSIONS This study demonstrates the capacity of smartwatches to speed up the point-of-care delivery of laboratory results in the ED.
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Affiliation(s)
- Thomas Boillat
- Mohammed Bin Rashid University of Medicine and Health Sciences, Design Lab, Dubai, United Arab Emirates.
| | - Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nadim Alduaij
- Department of Emergency Medicine, Dar Al Shifa Hospital, Hawally, Kuwait
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11
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Koziatek C, Swartz J, Iturrate E, Levy-Lambert D, Testa P. Decreasing the Lag Between Result Availability and Decision-Making in the Emergency Department Using Push Notifications. West J Emerg Med 2019; 20:666-671. [PMID: 31316708 PMCID: PMC6625675 DOI: 10.5811/westjem.2019.5.42749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/12/2019] [Accepted: 05/11/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Emergency department (ED) patient care often hinges 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 or disposition based on that result. We implemented a system that electronically alerts ED providers when test results are available for review via a smartphone- and smartwatch-push notification. We hypothesized this would reduce the time from result to clinical decision-making. Methods We retrospectively assessed the impact of the implementation of a push notification system at three EDs on time-to-disposition or time-to-follow-up order in six clinical scenarios of interest: chest radiograph (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 abnormal D-dimer to computed tomography pulmonary angiography (CTPA) order. All ED patients during a one-year period of push-notification availability were included in the study. The primary outcome was median time in each scenario from result availability to either disposition order or defined follow-up order. The secondary outcome was the overall usage rate of the opt-in push notification system by providers. Results During the study period there were 6115 push notifications from 4183 ED encounters (2.7% of all encounters). Of the six clinical scenarios examined in this study, five were associated with a decrease in median time from test result availability to patient disposition or follow-up order when push notifications were employed: CXR to disposition, 80 minutes (interquartile range [IQR] 32–162 minutes) vs 56 minutes (IQR 18–141 minutes), difference 24 minutes (p<0.01); BMP to disposition, 128 minutes (IQR 62–225 minutes) vs 116 minutes (IQR 33–226 minutes), difference 12 minutes (p<0.01); UA to disposition, 105 minutes (IQR 43–200 minutes) vs 55 minutes (IQR 16–144 minutes), difference 50 minutes (p<0.01); RPP to disposition, 80 minutes (IQR 28–181 minutes) vs 37 minutes (IQR 10–116 minutes), difference 43 minutes (p<0.01); and D-dimer to CTPA, 14 minutes (IQR 6–30 minutes) vs 6 minutes (IQR 2.5–17.5 minutes), difference 8 minutes (p<0.01). The sixth scenario, Hb to blood transfusion (difference 19 minutes, p=0.73), did not meet statistical significance. 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 and physician decision-making in the examined clinical scenarios. Push notifications were used in only a minority of ED patient encounters.
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Affiliation(s)
- Christian Koziatek
- New York University School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York City, New York
| | - Jordan Swartz
- New York University School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York City, New York
| | - Eduardo Iturrate
- New York University School of Medicine, Department of Medicine, New York City, New York
| | - Dina Levy-Lambert
- New York University School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York City, New York
| | - Paul Testa
- New York University School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York City, New York
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