Improving Response to Critical Laboratory Results with Automation: Results of a Randomized Controlled Trial

Kuperman, Gilad J.; Teich, Jonathan M.; Tanasijevic, Milenko J.; Ma’Luf, Nell; Rittenberg, Eve; Jha, Ashish K.; Fiskio, Julie M.; Winkelman, James W.; Bates, David W.

doi:10.1136/jamia.1999.0060512

Cited by 198 publications

(136 citation statements)

References 24 publications

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“…The system was evaluated in a pilot study of 4 tests (glucose, potassium, sodium, hematocrit) monitored over a 2-month period. The documented physician response rate in this limited study was 69% (8 ). This is nearly identical to our direct physician response rate before we instituted the 7-min reminder, which resulted in an eventual 89% rate.…”

Section: Discussionsupporting

confidence: 64%

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Implementation of a Closed-Loop Reporting System for Critical Values and Clinical Communication in Compliance with Goals of The Joint Commission

Parl¹,

O'Leary²,

Kaiser³

et al. 2010

Clinical Chemistry

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Background: Current practices of reporting critical laboratory values make it challenging to measure and assess the timeliness of receipt by the treating physician as required by The Joint Commission’s 2008 National Patient Safety Goals. Methods: A multidisciplinary team of laboratorians, clinicians, and information technology experts developed an electronic ALERTS system that reports critical values via the laboratory and hospital information systems to alphanumeric pagers of clinicians and ensures failsafe notification, instant documentation, automatic tracking, escalation, and reporting of critical value alerts. A method for automated acknowledgment of message receipt was incorporated into the system design. Results: The ALERTS system has been applied to inpatients and eliminated approximately 9000 phone calls a year made by medical technologists. Although a small number of phone calls were still made as a result of pages not acknowledged by clinicians within 10 min, they were made by telephone operators, who either contacted the same physician who was initially paged by the automated system or identified and contacted alternate physicians or the patient’s nurse. Overall, documentation of physician acknowledgment of receipt in the electronic medical record increased to 95% of critical values over 9 months, while the median time decreased to <3 min. Conclusions: We improved laboratory efficiency and physician communication by developing an electronic system for reporting of critical values that is in compliance with The Joint Commission’s goals.

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Section: Discussionsupporting

confidence: 64%

“…The amount of time spent by laboratories reporting thousands of crisis values per year is significant in hospitals that treat many critically ill patients. In recognition of the substantial commitment of effort and time, a few attempts have been made to develop automated systems for the reporting of critical values (8,9 ).…”

mentioning

confidence: 99%

Implementation of a Closed-Loop Reporting System for Critical Values and Clinical Communication in Compliance with Goals of The Joint Commission

Parl¹,

O'Leary²,

Kaiser³

et al. 2010

Clinical Chemistry

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“…Automated clinical surveillance systems are effective for a variety of clinical conditions including the identification of sepsis (19), adverse drug reactions (20,21), and more recently, AKI (22,23). These surveillance systems have assisted with faster identification of events compared with usual care that has been shown to improve shortterm progression of AKI severity (22,24,25). Future studies are needed to determine the effect of clinical surveillance systems used to detect AKI on long-term recovery of renal function, as well as how these systems can be further refined to enhance the detection and management of AKI.…”

Section: Discussionmentioning

confidence: 99%

AKI in Low-Risk versus High-Risk Patients in Intensive Care

Sileanu

Murugan

Lucko

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives AKI in critically ill patients is usually part of multiorgan failure. However, nonrenal organ failure may not always precede AKI and patients without evidence of these organ failures may not be at low risk for AKI. This study examined the risk and outcomes associated with AKI in critically ill patients with and without cardiovascular or respiratory organ failures at presentation to the intensive care unit (ICU).Design, setting, participants, & measurements A large, academic medical center database, with records from July 2000 through October 2008, was used and the authors identified a low-risk cohort as patients without cardiovascular and respiratory organ failures defined as not receiving vasopressor support or mechanical ventilation within the first 24 hours of ICU admission. AKI was defined using Kidney Disease Improving Global Outcomes criteria. The primary end points were moderate to severe AKI (stages 2-3) and risk-adjusted hospital mortality.Results Of 40,152 critically ill patients, 44.9% received neither vasopressors nor mechanical ventilation on ICU day 1. Stages 2-3 AKI occurred less frequently in the low-risk patients versus high-risk patients within 24 hours (14.3% versus 29.1%) and within 1 week (25.7% versus 51.7%) of ICU admission. Patients developing AKI in both risk groups had higher risk of death before hospital discharge. However, the adjusted odds of hospital mortality were greater (odds ratio, 2.99; 95% confidence interval, 2.62 to 3.41) when AKI occurred in low-risk patients compared with those with respiratory or cardiovascular failures (odds ratio, 1.19; 95% confidence interval, 1.09 to 1.3); interaction P,0.001.Conclusions Patients admitted to ICU without respiratory or cardiovascular failure have a substantial likelihood of developing AKI. Although survival for low-risk patients is better than for high-risk patients, the relative increase in mortality associated with AKI is actually greater for low-risk patients. Strategies aimed at preventing AKI should not exclude ICU patients without cardiovascular or respiratory organ failures.

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“…First, although numerous studies have reported that CIS use translates into benefits (e.g., fewer medication errors, [26][27][28][29] increased financial gain, 30 better quality of care, 31,32 improved practitioners' performance, 33-35 enhancement of diagnostic accuracy 36 and increased safety 3,37 ), computer systems that satisfy users and that actually contribute to the quality and safety of patient care are rare. [4][5][6][38][39][40][41][42] By depicting the dynamics of the implementation process, our study helps to explain why this is so.…”

Section: Discussionmentioning

confidence: 99%

Getting physicians to accept new information technology: insights from case studies

Lapointe

Rivard²

2006

Canadian Medical Association Journal

162

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ResearchT he potential contribution of a clinical information system (CIS) to the quality of health care 1-3 is generally acknowledged, and numerous hospitals have been engaged in their implementation. [4][5][6] Investment in information technology (IT) in the health care sector is higher than ever. Physicians play a critical role in the success of CIS implementation, 10-13 but many are reluctant to use IT tools. 14,15Rather than viewing resistance as a barrier to be removed, 16or taking for granted that resistance will be dysfunctional and even destructive, 17 we considered that it can also be useful in preventing the implementation of systems that are flawed 18 or that would have negative organizational impacts. 17 We analyzed cases of CIS implementation in 3 hospitals to understand better the dynamics of physicians' resistance to CIS implementation. We also sought to determine whether resistance was an a priori reaction or whether it developed only later, during the implementation. MethodsFor our analytical framework, we drew from a model that suggests that, when a CIS is introduced, resistance behaviours occur if users perceive threats from the interaction of initial conditions and system features.12 During implementation, triggers may change the nature of the initial conditions or change the object of resistance, and resistance behaviours may vary in intensity, from apathy to aggressive actions (Appendix 1). 12For our study, we selected 3 hospitals in which CIS had been or was being implemented. The cases were selected with enough similarities and differences so as to maximize variation and allow for comparison (Table 1). 19,20For data collection, we used direct observation, documentation and interviews, with interviews being the principal source of data. The initial people interviewed were the project manager, the nursing director and the medical director at each hospital. A snowball sampling strategy 21,22 was then used, whereby those interviewed identified additional people whom they thought held critical information about the project, had exhibited extreme behaviours of acceptance or resistance, or portrayed the typical behaviours of their professional group. Data collection ended when information obtained from additional respondents could not be justified in terms of effort and resources.23 We used open-ended questions and asked respondents to describe the implementation, from project initiation to termination. Following an interview protocol, additional questions were prompted to ensure data completeness Getting physicians to accept new information technology: insights from case studies Background: : The success or failure of a computer information system (CIS) depends on whether physicians accept or resist its implementation. Using case studies, we analyzed the implementation of such systems in 3 hospitals to understand better the dynamics of physicians' resistance to CIS implementation.Methods: : We selected cases to maximize variation while allowing comparison of CIS implementations. Data were coll...

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Improving Response to Critical Laboratory Results with Automation: Results of a Randomized Controlled Trial

Abstract: 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.

Cited by 198 publications

References 24 publications

Implementation of a Closed-Loop Reporting System for Critical Values and Clinical Communication in Compliance with Goals of The Joint Commission

Implementation of a Closed-Loop Reporting System for Critical Values and Clinical Communication in Compliance with Goals of The Joint Commission

AKI in Low-Risk versus High-Risk Patients in Intensive Care

Getting physicians to accept new information technology: insights from case studies

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