An Automatic Notification System for Test Results Finalized After Discharge

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Anuj K. Dalal, MD, Brigham and Women's Hospital
ClinicalTrials.gov Identifier:
NCT01153451
First received: June 3, 2010
Last updated: June 4, 2013
Last verified: June 2013
  Purpose

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.


Condition Intervention
Test Result Management
Other: Email Notification

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Caregiver)
Primary Purpose: Health Services Research
Official Title: An Automatic Notification System for Test Results Finalized After Discharge

Further study details as provided by Brigham and Women's Hospital:

Primary Outcome Measures:
  • Percent of Inpatient Providers Aware of Finalized Results of Tests Pending at Discharge (Study 1) [ Time Frame: 72 hours after notification, October 2010 thru May 2011 ] [ Designated as safety issue: No ]
    The primary outcome will be the percentage of inpatient physicians who are aware of the finalized results of tests pending at discharge.


Secondary Outcome Measures:
  • Percent of Ambulatory Providers Aware of Finalized Results of Tests Pending at Discharge (Study 1) [ Time Frame: 72 hours after notification, October 2010 thru May 2011 ] [ Designated as safety issue: No ]
    Secondary outcomes will include the percentage of ambulatory physicians who are aware of the finalized results of tests pending at discharge (both Partners network and non-network providers).

  • Percent of Providers Aware of Actionable Test Results (Study 1) [ Time Frame: 72 hours after notification, October 2010 thru May 2011 ] [ Designated as safety issue: No ]
    Percent awareness of actionable test results by responsible providers

  • Provider Satisfaction (Study 1) [ Time Frame: 72 hours after notification, October 2010 thru May 2011 ] [ Designated as safety issue: No ]
    Percentage of providers satisfied with the notification system.


Other Outcome Measures:
  • Proportion of potentially actionable TPAD results with documented action(s) taken in the intervention versus control arms. (Primary Outcome, Study 2) [ Time Frame: Retrospective chart data abstraction for patients discharged from July 2011 through July 2012 ] [ Designated as safety issue: No ]
    The primary outcome will be measured as the difference in the proportion of potentially actionable TPAD results with documented actions taken (as determined by electronic chart review) per discharged patient in the intervention and control arm.

  • Proportion of potentially actionable TPAD results with documented acknowledgement in the intervention versus control arms. (Secondary Outcome, Study 2) [ Time Frame: Retrospective chart data abstraction for patients discharged from July 2011 through July 2012 ] [ Designated as safety issue: No ]
    The secondary outcome will be measured as the difference in the proportion of potentially actionable TPAD results with documented acknowledgment (as determined by electronic chart review) in the intervention and control arm.


Enrollment: 441
Study Start Date: October 2010
Study Completion Date: July 2012
Primary Completion Date: May 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: Usual Care
Responsible inpatient and ambulatory physicians assigned to usual care will not receive any email(s) of patients' test results generated from the notification system.
Email Notification
Responsible inpatient and ambulatory physicians will receive automated email(s) of patients' tests results finalized post-discharge generated from the notification system. Finalized results will be batched such that no provider will receive more than one email per day.
Other: Email Notification
BWH inpatient clinical information systems will automatically file all non-finalized chemistry, hematology, pathology, and radiology tests, as well as inpatient and ambulatory provider email addresses for all study patients discharged. This process will be initiated using a time stamp most proximate to actual discharge time. At midnight on every day, all tests filed at time of discharge will be updated if final results have become available. An email with all finalized and pending test results for each patient discharged will be sent to the inpatient and primary care provider at this time. For patients discharged with more than one pending test, subsequent email notification(s) will be sent out until all pending tests are finalized (no more than one email per day).

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

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
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.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01153451

Locations
United States, Massachusetts
Brigham and Women's Hospital
Boston, Massachusetts, United States, 02115
Sponsors and Collaborators
Brigham and Women's Hospital
Investigators
Principal Investigator: Anuj K Dalal, MD Brigham and Women's Hospital
  More Information

No publications provided by Brigham and Women's Hospital

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Anuj K. Dalal, MD, Associate Physician, Brigham and Women's Hospital
ClinicalTrials.gov Identifier: NCT01153451     History of Changes
Other Study ID Numbers: 1R21HS018229-01, CRICO
Study First Received: June 3, 2010
Last Updated: June 4, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by Brigham and Women's Hospital:
Pending tests
Discharge
Awareness
Care transitions

ClinicalTrials.gov processed this record on October 29, 2014