Effectiveness of automated notification and customer service call centers for timely and accurate reporting of critical values: A laboratory medicine best practices systematic review and meta-analysis

Abstract

Objective-To conduct a systematic review of automatic notification methods and consider evidence-based recommendations for best practices in improving the timeliness and accuracy of critical value reporting.Results-196 bibliographic records were identified, with nine meeting review inclusion criteria. Four studies examined automated notification systems and five assessed call center performance. Average improvement from implementing automated notification systems is d = 0.42 (95% CI = 0.2 -0.62) while the average odds ratio for call centers is OR = 22.1 (95% CI = 17.1 -28.6).Conclusions-The evidence, though suggestive, is not sufficient to make a recommendation for or against using automated notification systems as a best practice to improve the timeliness and accuracy of critical value reporting in an in-patient care setting. Call centers, however, are effective in improving the timeliness and accuracy of critical value reporting in an in-patient care setting, and are recommended as an "evidence-based best practice." KeywordsClinical laboratory information systems; critical care methods; hospital laboratory organization and administration; medical laboratory personnel organization and administration Corresponding Author: Edward Liebow, Battelle Centers for Public Health Research and Evaluation, 1100 Dexter Ave N, Suite 400, .6683, liebowe@battelle.org. Human Subjects ProtectionNo human subjects research was conducted for the purposes of the findings reported here. The attention directed towards improvements for critical value notification is driven by the assumption that timely reporting will lead to timely clinical interventions and corresponding secondary prevention of co-morbidities and more effective treatment outcomes. Despite the number of entities interested in improving critical value reporting, evidence has been lacking concerning which practices are effective at achieving these improvements. HHS Public AccessImplementing an effective critical value reporting system is concomitantly complex ( Figure 1 Quality Gap: Manual Notification of Critical ValuesThe standard notification mode in most healthcare facilities includes a manual process of contacting clinicians, connecting them to the laboratory, and conveying critical results verbally. When contact is not successfully completed, escalation procedures are followed, based on routing rules and procedures relevant to the indications for testing, the clinician who ordered the test, attending clinicians, and finally, supervising clinicians. This is often a time-consuming practice that diverts the laboratorian's attention from other laboratory work, frequently results in the handoff of information to an intermediary, and creates opportunities for transfer errors and reporting delays. Alternative mechanisms that have been instituted to replace the standard laboratory phone contact efforts include the use of automated notification systems and call centers (also known as "customer service centers"). Practice Descriptions MethodsThis evidence review ...

Editorial: Automated critical value reporting; a contribution to systematization of clinical care and the value of laboratory medicine

“…The study reported by Piva et al has taken forward their previous work [24,25], and the conclusions from the meta-analysis of Liebow et al [22], by auditing the actions taken by the physicians on receipt of the critical value alert. They showed that the three main actions were (a) initiation of new treatment in at least 90% of alerts, (b) further evaluation work -in at least 60% of alerts and (c) closer monitoring -in at least 25% of alerts.…”

“…Christenson et al described an initiative for collecting data from the use of tools developed and assessed in quality improvement programs [19,20]; the overall objective being "doing things right" [21], and to make better use of this type of observational data. These tools can take several forms, e.g., checklists, patient and specimen identifiers, and automatic alerts [22,23]. They are all designed to make practice more systematic … more precise.…”

Clinical laboratories: production industry or medical services?

“…Examples of debatable issues include direct access to laboratory tests, and the direct reporting of laboratory results to the patient [37], aspects that, in the era of genomics, highlight the need for an approach based on ethics and patient safety, rather than on economics. For example, the notification of critical values has been described as a time-consuming and expensive activity that should be outsourced to call centers [38]. Yet critical results, which are frequently unexpected, may call for a change in treatment and can result in significant clinical benefit if issued promptly, and accompanied by clinical advice from laboratory professionals [39].…”

Assessing Clinical Microbiology Practice Guidelines: American Society for Microbiology Ad Hoc Committee on Evidence-Based Laboratory Medicine Practice Guidelines Assessment

“…improve health care quality. A number of LMBP systematic reviews have been published, including reports on patient specimen identification and the effectiveness of barcoding (5), critical value reporting (6), practices to reduce blood sample hemolysis in emergency departments (7), and cardiac biomarkers (8) and several in clinical microbiology (9,10).…”