Push-Alert Notification of Troponin Results to Physician Smartphones Reduces the Time to Discharge Emergency Department Patients: A Randomized Controlled Trial - 29/08/17
, Angela S. Wang, MD, MSc a, Michael J. Feldman, MD, PhD a, b, Darren A. Hefferon b, Alex Kiss, PhD c, Jacques S. Lee, MD, MSc a, bAbstract |
Study objective |
For emergency department (ED) patients with chest pain, discharge decisions often hinge on troponin results. Push-alert notifications deliver results immediately to physician smartphones. Our objective is to determine whether troponin push alerts improve the time to discharge decisions for ED patients with chest pain.
Methods |
In an academic ED, we assessed the effect of a quality improvement initiative using troponin push alerts to physician smartphones, with a cluster-randomized evaluation. Participating physicians were randomized to receive troponin push alerts (intervention) or not receive them (control). We retrospectively identified patients treated by participating physicians during the study period who were discharged from the ED with chest pain. The primary outcome was the time from final troponin result to discharge decision. Secondary outcomes included length of stay. A linear mixed model was used to adjust for physician clustering.
Results |
During the study, 1,554 patients were discharged from the ED with chest pain. There were 551 patients in the control group and 554 in the intervention group who met inclusion criteria. The overall median interval from final troponin result to discharge decision was 79.7 minutes (interquartile range [IQR] 33.6 to 167.8 minutes); it was 94.3 minutes (IQR 36.2 to 177.8 minutes) in the control group and 68.5 minutes (IQR 30.5 to 157.2 minutes) in the intervention group. This 25.8-minute difference in medians (95% confidence interval 24.6 to 28.0 minutes) was statistically significant. Total ED length of stay was 345 minutes (IQR 261 to 419 minutes) in the control group and 328 minutes (IQR 250 to 408 minutes) in the intervention group.
Conclusion |
Physicians who received troponin push alerts discharged their patients with chest pain 26 minutes faster than those without troponin notifications. Total ED length of stay did not significantly improve for these patients.
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| Please see page 349 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD |
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| Author contributions: AV, ASW, and MJF conceived the study idea. AV, ASW, MJF, and JSL designed the study and contributed to the Research Ethics Board application. AV recruited physicians into the study, and ASW randomized them into groups. MJF and DAH implemented and maintained the push-alert program. DAH was responsible for all technical and programming aspects of the study, including providing technical advice for study design, electronic identification of eligible patients, managing the Emergency Department Information System database, and obtaining study results. AK and JSL were responsible for all aspects of statistical analysis of results. AV drafted the article, with substantial contribution from JSL, particularly in the results and statistical analysis sections. All authors contributed to article revision. AV takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. |
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Vol 70 - N° 3
P. 348-356 - septembre 2017 Retour au numéro
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