Improving response to critical laboratory results with automation: Resultsof a randomized controlled trial

Objective: To evaluate the effect of an automatic alerting system on the ti me until treatment is ordered fur patients with critical laboratory results . Design: Prospective randomized controlled trial. Intervention: A computer system to detect critical conditions and automatic ally notify the responsible physician via the hospital's paging system. Patients: Medical and surgical inpatients at a large academic medical cente r. One two-month study period for each service. Main outcomes: Interval from when a critical result was available for revie w until an appropriate treatment was ordered. Secondary outcomes were the t ime until the critical condition resolved and the frequency of adverse even ts. 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 p atients, no automatic notification was made. Chart review was performed to determine the outcomes. Results: After exclusions, 192 alerting situations (94 interventions, 98 co ntrols) were analyzed. The intervention group had a 38 percent shorter medi an time interval (1.0 hours vs. 1.6 hours, P = 0.003; mean, 4.1 vs. 4.6 hou rs, P = 0.003) until an appropriate treatment was ordered. The time until t he 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 = 0.1 1), although these results did not achieve statistical significance. The im pact of the intervention was more pronounced for alerts that did not meet t he laboratory's critical reporting criteria. There was no significant diffe rence between the two groups in the number of adverse events. Conclusion: An automatic alerting system reduced the time until an appropri ate treatment was ordered for patients who had critical laboratory results. Information technologies that facilitate the transmission of important pat ient data can potentially improve the quality of care.