An Automatic Notification System for Test Results Finalized after Discharge

摘要：出院后向门诊环境的过渡是患者的一个脆弱时期。一个重要的患者安全问题是负责任的提供者未能可靠地跟踪患者出院后确定的检测结果。这种失败可能导致诊断延误、错过治疗机会、重复安排检查以及随后对患者造成伤害。确保将这些检测结果及时通知给负责任的提供者的自动化系统有可能减轻这些记录良好的问题，并提高医疗保健质量和安全性。该项目的目标是创建一个基于信息技术的自动通知系统，在出院后将最终确定的检测结果提示负责任的医生，并评估该系统对医生了解这些检测结果的影响。在本研究的第一阶段，将设计系统的组成部分。这包括1)查询出院时尚未得出最终结果的所有测试，2)查询身份和电子邮件

DESCRIPTION (provided by applicant): Abstract: The transition to the ambulatory setting following hospital discharge is a vulnerable time for patients. One important patient safety concern is failure of responsible providers to reliably follow up test results finalized after a patient is discharged. Such failure can lead to delays in diagnosis, missed treatment opportunities, redundant ordering of tests, and subsequent patient harm. Automated systems that ensure timely notification of these test results to responsible providers have the potential to mitigate these well documented problems and improve health care quality and safety. The goals of this project are to create an information technology-based automatic notification system to prompt responsible physicians of test results finalized after discharge and to evaluate the impact of this system on physician awareness of these test results. In the first phase of this study, the components of the system will be designed. These include 1) a query of all tests whose final results are pending at the time of discharge, 2) a query for the identity and email addresses of the patient's responsible inpatient and ambulatory provider, 3) logic to exclude routinely ordered inpatient tests to avoid provider alert fatigue, 4) automatic email notification of finalized test results to responsible providers once they are available, and 5) documentation of these results in the ambulatory electronic medical record. The system is designed to facilitate timely communication and the creation of a collaborative plan of care among inpatient and outpatient providers during a patient's transition to the ambulatory setting. A cluster randomized controlled trial will be conducted to measure the impact of such a system on physician awareness. To minimize contamination, both inpatient and ambulatory providers will be randomized, and patients will only be enrolled if both responsible physicians are in the same arm of the study. Study subjects will include patients discharged from the inpatient general medicine and cardiology services at Brigham and Women's Hospital. The primary outcome will be awareness of all post-discharge test results among responsible providers. Secondary outcomes will include user satisfaction, awareness of actionable test results (as judged by providers), and whether appropriate actions are subsequently taken in response to these results (based on electronic medical record review). Physician awareness will be determined using an email survey to providers 72 hours after the first finalized test result is available. The primary outcome will be analyzed as the proportion of test results per patient of which a provider is aware using binomial logistic regression. General estimating equations will be used to adjust for patient and physician characteristics and to cluster by physician. Over a six-month study period, 450 patients will be enrolled in order to provide adequate power to detect an improvement in awareness from 40% to 60% of results. The results of this study will inform future efforts to optimize this type of intervention both at BWH and at other institutions trying to solve this important patient safety problem.