| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Research Paper |
1 Partners HealthCare System.
2 Harvard Medical School, Boston, Massachusetts.
Gilad J. Kuperman, MD, PhD, Partners HealthCare System, Department of Information Systems, 850 Boylston Street, Suite 202, Chestnut Hill, MA 02467. e-mail: <gkuperman{at}partners.org >.
Objective: To evaluate the effect of an automatic alerting system on the time until treatment is ordered for patients with critical laboratory results.
Design: Prospective randomized controlled trial.
Intervention: A computer system to detect critical conditions and automatically notify the responsible physician via the hospital's paging system.
Patients: Medical and surgical inpatients at a large academic medical center. One two-month study period for each service.
Main outcomes: Interval from when a critical result was available for review until an appropriate treatment was ordered. Secondary outcomes were the time until the critical condition resolved and the frequency of adverse events.
Methods: The alerting system looked for 12 conditions involving laboratory results and medications. For intervention patients, the covering physician was automatically notified about the presence of the results. For control patients, no automatic notification was made. Chart review was performed to determine the outcomes.
Results: After exclusions, 192 alerting situations (94 interventions, 98 controls) were analyzed. The intervention group had a 38 percent shorter median time interval (1.0 hours vs. 1.6 hours, P = 0.003; mean, 4.1 vs. 4.6 hours, P = 0.003) until an appropriate treatment was ordered. The time until the alerting condition resolved was less in the intervention group (median, 8.4 hours vs. 8.9 hours, P = 0.11; mean, 14.4 hours vs. 20.2 hours, P = 0.11), although these results did not achieve statistical significance. The impact of the intervention was more pronounced for alerts that did not meet the laboratory's critical reporting criteria. There was no significant difference between the two groups in the number of adverse events.
Conclusion: An automatic alerting system reduced the time until an appropriate treatment was ordered for patients who had critical laboratory results. Information technologies that facilitate the transmission of important patient data can potentially improve the quality of care.
This article has been cited by other articles:
 |
|
 |
|
  J. L. Schnipper, J. A. Linder, M. B. Palchuk, J. S. Einbinder, Q. Li, A. Postilnik, and B. Middleton "Smart Forms" in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 513 - 523. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Staes, R. S. Evans, B. H.S.C. Rocha, J. B. Sorensen, S. M. Huff, J. Arata, and S. P. Narus Computerized Alerts Improve Outpatient Laboratory Monitoring of Transplant Patients J. Am. Med. Inform. Assoc., May 1, 2008; 15(3): 324 - 332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-i. Park, W.-K. Min, W. Lee, H. Park, C.-J. Park, H.-S. Chi, and S. Chun Evaluating the Short Message Service Alerting System for Critical Value Notification via PDA Telephones Ann. Clin. Lab. Sci., January 1, 2008; 38(2): 149 - 156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Singh, H. S. Arora, M. S. Vij, R. Rao, M. M. Khan, and L. A. Petersen Communication Outcomes of Critical Imaging Results in a Computerized Notification System J. Am. Med. Inform. Assoc., July 1, 2007; 14(4): 459 - 466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Handler, R. L. Altman, S. Perera, J. T. Hanlon, S. A. Studenski, J. E. Bost, M. I. Saul, and D. B. Fridsma A Systematic Review of the Performance Characteristics of Clinical Event Monitor Signals Used to Detect Adverse Drug Events in the Hospital Setting J. Am. Med. Inform. Assoc., July 1, 2007; 14(4): 451 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Rubin, K. Bateman, S. Donnelly, G. J. Stoddard, K. Stevenson, R. M. Gardner, and M. H. Samore Use of a Personal Digital Assistant for Managing Antibiotic Prescribing for Outpatient Respiratory Tract Infections in Rural Communities J. Am. Med. Inform. Assoc., November 1, 2006; 13(6): 627 - 634. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Lapointe and S. Rivard Getting physicians to accept new information technology: insights from case studies. Can. Med. Assoc. J., May 23, 2006; 174(11): 1573 - 1578. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Chaudhry, J. Wang, S. Wu, M. Maglione, W. Mojica, E. Roth, S. C. Morton, and P. G. Shekelle Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care Ann Intern Med, May 16, 2006; 144(10): 742 - 752. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Lin, A. Dunn, and C. Moore Follow-up of Outpatient Test Results: A Survey of House-Staff Practices and Perceptions. American Journal of Medical Quality, May 1, 2006; 21(3): 178 - 184. [Abstract] [PDF]
|
|
|
|
|
|
R. Kaushal, A. K. Jha, C. Franz, J. Glaser, K. D. Shetty, T. Jaggi, B. Middleton, G. J. Kuperman, R. Khorasani, M. Tanasijevic, et al. Return on Investment for a Computerized Physician Order Entry System J. Am. Med. Inform. Assoc., May 1, 2006; 13(3): 261 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. T. Rosenbloom, K.-W. Chiu, D. W. Byrne, D. A. Talbert, E. G. Neilson, and R. A. Miller Interventions to Regulate Ordering of Serum Magnesium Levels: Report of an Unintended Consequence of Decision Support J. Am. Med. Inform. Assoc., September 1, 2005; 12(5): 546 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. T. Rosenbloom, A. J. Geissbuhler, W. D. Dupont, D. A. Giuse, D. A. Talbert, W. M. Tierney, W. D. Plummer, W. W. Stead, and R. A. Miller Effect of CPOE User Interface Design on User-Initiated Access to Educational and Patient Information during Clinical Care J. Am. Med. Inform. Assoc., July 1, 2005; 12(4): 458 - 473. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. X. Garg, N. K. J. Adhikari, H. McDonald, M. P. Rosas-Arellano, P. J. Devereaux, J. Beyene, J. Sam, and R. B. Haynes Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review JAMA, March 9, 2005; 293(10): 1223 - 1238. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. K. Gandhi Fumbled Handoffs: One Dropped Ball after Another Ann Intern Med, March 1, 2005; 142(5): 352 - 358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. L. Galanter, A. Polikaitis, and R. J. DiDomenico A Trial of Automated Safety Alerts for Inpatient Digoxin Use with Computerized Physician Order Entry J. Am. Med. Inform. Assoc., July 1, 2004; 11(4): 270 - 277. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Frankel, T. K. Gandhi, and D. W. Bates Improving patient safety across a large integrated health care delivery system Int. J. Qual. Health Care, December 1, 2003; 15(90001): i31 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. N. Weingart, M. Toth, D. Z. Sands, M. D. Aronson, R. B. Davis, and R. S. Phillips Physicians' Decisions to Override Computerized Drug Alerts in Primary Care Arch Intern Med, November 24, 2003; 163(21): 2625 - 2631. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Hoch, A. D. Heymann, I. Kurman, L. J. Valinsky, G. Chodick, and V. Shalev Countrywide Computer Alerts to Community Physicians Improve Potassium Testing in Patients Receiving Diuretics J. Am. Med. Inform. Assoc., November 1, 2003; 10(6): 541 - 546. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Bates and A. A. Gawande Improving Safety with Information Technology N. Engl. J. Med., June 19, 2003; 348(25): 2526 - 2534. [Full Text] [PDF]
|
|
|
|
|
|
D. F. Doolan, D. W. Bates, and B. C. James The Use of Computers for Clinical Care: A Case Series of Advanced U.S. Sites J. Am. Med. Inform. Assoc., January 1, 2003; 10(1): 94 - 107. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Fritsche, A. Schlaefer, K. Budde, K. Schroeter, and H.-H. Neumayer Recognition of Critical Situations from Time Series of Laboratory Results by Case-Based Reasoning J. Am. Med. Inform. Assoc., September 1, 2002; 9(5): 520 - 528. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Bates Unexpected Hypoglycemia in a Critically Ill Patient Ann Intern Med, July 16, 2002; 137(2): 110 - 116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. G. Poon, G. J. Kuperman, J. Fiskio, and D. W. Bates Real-time Notification of Laboratory Data Requested by Users through Alphanumeric Pagers J. Am. Med. Inform. Assoc., May 1, 2002; 9(3): 217 - 222. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Lovis, M. K. Chapko, D. P. Martin, T. H. Payne, R. H. Baud, P. J. Hoey, and S. D. Fihn Evaluation of a Command-line Parser-based Order Entry Pathway for the Department of Veterans Affairs Electronic Patient Record J. Am. Med. Inform. Assoc., September 1, 2001; 8(5): 486 - 498. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
