Impact of an electronic alert notification system embedded in radiologists’ workflow on closed-loop communication of critical results: a time series analysis

BMJ Quality and Safety - Tập 25 Số 7 - Trang 518-524 - 2016
Ronilda Lacson1, Stacy D. O’Connor2,3, V. Anik Sahni2,3, Christopher L. Roy4,3, Anuj K. Dalal4,3, Sonali Desai5,3, Ramin Khorasani2,3
1Department of Radiology, Brigham and Women's Hospital, 75 Francis Street Boston, MA 02115, USA
2Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA
3Harvard Medical School Boston Massachusetts USA
4Department of Medicine, Brigham and Women's Hospital Boston, Massachusetts USA
5Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Tóm tắt

IntroductionOptimal critical test result communication is a Joint Commission national patient safety goal and requires documentation of closed-loop communication among care providers in the medical record. Electronic alert notification systems can facilitate an auditable process for creating alerts for transmission and acknowledgement of critical test results. We evaluated the impact of a patient safety initiative with an alert notification system on reducing critical results lacking documented communication, and assessed potential overuse of the alerting system for communicating results.MethodsWe implemented an alert notification system—Alert Notification of Critical Results (ANCR)—in January 2010. We reviewed radiology reports finalised in 2009–2014 which lacked documented communication between the radiologist and another care provider, and assessed the impact of ANCR on the proportion of such reports with critical findings, using trend analysis over 10 semiannual time periods. To evaluate potential overuse of ANCR, we assessed the proportion of reports with non-critical results among provider-communicated reports.ResultsThe proportion of reports with critical results among reports without documented communication decreased significantly over 4 years (2009–2014) from 0.19 to 0.05 (p<0.0001, Cochran–Armitage trend test). The proportion of provider-communicated reports with non-critical results remained unchanged over time before and after ANCR implementation (0.20 to 0.15, p=0.45, Cochran–Armitage trend test).ConclusionsA patient safety initiative with an alert notification system reduced the proportion of critical results among reports lacking documented communication between care providers. We observed no change in documented communication of non-critical results, suggesting the system did not promote overuse. Future studies are needed to evaluate whether such systems prevent subsequent patient harm.

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Tài liệu tham khảo

Joint Commission. National Patient Safety Goals, 2013. http://www.jointcommission.org/standards_information/npsgs.aspx

10.1197/jamia.M2280

Howanitz, 2002, Laboratory critical values policies and procedures: a College of American Pathologists Q-Probes Study in 623 institutions, Arch Pathol Lab Med, 126, 663, 10.5858/2002-126-0663-LCVPAP

10.1001/archinte.167.19.2030

10.1016/j.jamcollsurg.2007.01.010

10.1111/j.1525-1497.2004.30357.x

10.7326/0003-4819-143-2-200507190-00011

10.7326/0003-4819-142-5-200503010-00010

10.1001/archinternmed.2009.263

10.1373/clinchem.2009.135376

10.1007/s11606-007-0393-z

10.1136/amiajnl-2013-002030

Roy, 2013, An initiative to improve the management of clinically significant test results in a large health care network, Jt Comm J Qual Patient Saf, 39, 517

10.1016/j.jacr.2009.10.012

10.1136/bmjqs.2010.044339

10.1148/radiol.11101396

Brigham and Women's Hospital Department of Radiology. Policy and procedure on critical test result notification. http://www.brighamandwomens.org/research/labs/cebi/files/Radiology%20Policy%20Critical-Discrepant%20Results.pdf 1-31-2006. 3-10-2009

10.2214/AJR.14.13063

10.2214/AJR.14.13064

Kreimer, 2011, Quality & safety. Alarming: Joint Commission, FDA set to tackle alert fatigue, Hosp Health Netw, 85, 18

10.1136/amiajnl-2012-001089

10.1001/archinte.163.21.2625

10.1007/s10278-012-9463-9

10.2307/2529310

10.1148/rg.294095006

10.7326/0003-4819-151-1-200907070-00005

10.1007/s00247-008-0989-4

10.1016/j.jacr.2012.12.009

10.1016/j.crad.2011.05.013

10.1197/jamia.M1370

10.1136/amiajnl-2013-001684

10.1016/S1086-5802(16)31243-8

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BMJ Quality and Safety

Tập 25 Số 7

518-524

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