J Am Med Inform Assoc - Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial.

Tópicos

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Resumo

CKGROUND AND OBJECTIVE: Physician awareness of the results of tests pending at discharge (TPADs) is poor. We developed an automated system that notifies responsible physicians of TPAD results via secure, network email. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results.METHODS: We conducted a cluster-randomized controlled trial at a major hospital affiliated with an integrated healthcare delivery network in Boston, Massachusetts. Adult patients with TPADs who were discharged from inpatient general medicine and cardiology services were assigned to the intervention or usual care arm if their inpatient attending physician and primary care physician (PCP) were both randomized to the same study arm. Patients of physicians randomized to discordant study arms were excluded. We surveyed these physicians 72 h after all TPAD results were finalized. The primary outcome was awareness of TPAD results by attending physicians. Secondary outcomes included awareness of TPAD results by PCPs, awareness of actionable TPAD results, and provider satisfaction.RESULTS: We analyzed data on 441 patients. We sent 441 surveys to attending physicians and 353 surveys to PCPs and received 275 and 152 responses from 83 different attending physicians and 112 different PCPs, respectively (attending physician survey response rate of 63%). Intervention attending physicians and PCPs were significantly more aware of TPAD results (76% vs 38%, adjusted/clustered OR 6.30 (95% CI 3.02 to 13.16), p<0.001; 57% vs 33%, adjusted/clustered OR 3.08 (95% CI 1.43 to 6.66), p=0.004, respectively). Intervention attending physicians tended to be more aware of actionable TPAD results (59% vs 29%, adjusted/clustered OR 4.25 (0.65, 27.85), p=0.13). One hundred and eighteen (85%) and 43 (63%) intervention attending physician and PCP survey respondents, respectively, were satisfied with this intervention.CONCLUSIONS: Automated email notification represents a promising strategy for managing TPAD results, potentially mitigating an unresolved patient safety concern.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT01153451).

Resumo Limpo

ckground object physician awar result test pend discharg tpad poor develop autom system notifi respons physician tpad result via secur network email sought evalu impact system selfreport awar tpad result respons physician necessari intermediari step improv manag tpad resultsmethod conduct clusterrandom control trial major hospit affili integr healthcar deliveri network boston massachusett adult patient tpad discharg inpati general medicin cardiolog servic assign intervent usual care arm inpati attend physician primari care physician pcp random studi arm patient physician random discord studi arm exclud survey physician h tpad result final primari outcom awar tpad result attend physician secondari outcom includ awar tpad result pcps awar action tpad result provid satisfactionresult analyz data patient sent survey attend physician survey pcps receiv respons differ attend physician differ pcps respect attend physician survey respons rate intervent attend physician pcps signific awar tpad result vs adjustedclust ci p vs adjustedclust ci p respect intervent attend physician tend awar action tpad result vs adjustedclust p one hundr eighteen intervent attend physician pcp survey respond respect satisfi interventionconclus autom email notif repres promis strategi manag tpad result potenti mitig unresolv patient safeti concernclin trial registr clinicaltrialsgov nct

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