Result Push Notifications Improve Time to Emergency Department Disposition: A Pragmatic Observational Study - 24/09/24
, Lisette Dunham, MSPH, MPS b, Dustin S. McEvoy, BS b, Rebecca E. Cash, PhD a, Melissa A. Meeker, PhD a, Benjamin A. White, MD aAbstract |
Study objective |
Emergency department (ED) crowding has multiple causative factors, including delayed patient throughput. Patient care efficiency may be improved by addressing delays in decisionmaking following diagnostic testing results. We examined the influence of sending subscribed result push notifications to ED clinicians' smartphones on reducing the time to disposition decision.
Results |
All ED patient visits between October 2022 and October 2023 with a laboratory or imaging result during the ED visit and a disposition within 6 hours of the last result were included. We identified whether the last resulted study before the ED disposition decision had a subscribed push notification by the clinician who dispositioned the patient. The primary outcome was the time between the last study result and the first disposition decision. Generalized estimating equation analysis was used to control for variables including patient demographics, clinical factors, and discharging clinician.
Results |
The final study population included 237,872 encounters. The median patient age was 50 years, and 55.6% of patients were women. During the study period, 27.1% of clinicians used push notifications at least once. Of unique orders, 1.5% had a subscribed result push notification, including 0.9% of laboratory orders and 4.7% of imaging orders. The time between last result to disposition decision was 18 minutes (95% confidence interval [CI] 15 to 21) faster when a push notification was requested.
Conclusion |
Elective push notification of test results was associated with reduced time between the last laboratory or imaging result and ED disposition decision. Further study is needed to determine its effect on overall ED throughput.
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| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Stephen Schenkel, MD, MPP. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: SD conceived the study and served as lead author. SD, REC, and MAM designed the study and developed the statistical plan. LD and DSM extracted the data. SD performed the statistical analysis with guidance by RED and MAM. BAW provided subject matter expertise. SD and BAW drafted the manuscript, and all authors contributed substantially to its revision. SD takes responsibility for the paper as a whole. |
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| Data sharing statement: Data are not shareable as per IRB. SQL queries and analytic code for this investigation are available on request, from the date of article publication by contacting Sayon Dutta, MD, at sdutta@mgh.harvard.edu. |
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| Authorship: 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/). This study was conducted without financial support. The authors have no conflict of interest relevant to this article to disclose. |
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