Delivering lab results immediately to a specially provided smartphone helps physicians discharge patients significantly faster from the ED, according to recent research.
Chest pain patients whose attending emergency physicians received lab results delivered directly to their smartphones spent about 26 minutes less waiting to be discharged than patients whose lab results were delivered to the electronic patient record on the hospital computer system. (An abstract of the study is available online at: http://bit.ly/2sKf7So.)
For patients waiting for lab results, 26 minutes is significant, even if the smartphone process did not significantly shorten overall length of stay, says study author Aikta Verma, MD, MHSc, FRCPC, director of clinical operations in the Department of Emergency Services at Sunnybrook Health Sciences Centre, and assistant program director of the Emergency Medicine Residency Program at the University of Toronto.
The research focused on lab results for troponin levels, which are measured to differentiate between unstable angina and myocardial infarction in people with chest pain or acute coronary syndrome.
The results often determine if the patient stays in the hospital or goes home. In this study, the overall median interval from final troponin results to discharge decision was 79.7 minutes. For the control group (no smartphone), it was 94.3 minutes, and for the intervention group (smartphone) it was 68.5 minutes. The difference of 25.8 minutes is statistically significant, Verma notes.
The total ED length of stay was 345 minutes in the control group and 328 minutes in the intervention group, which the researchers did not consider statistically significant.
There are many other results that also could be pushed to smartphones, Verma notes, including other critical lab results, radiology reports, and vital signs.
Lag Time Reduced
Verma notes there are not a lot of things that address the lag time between lab results being available and physicians reviewing those results, which is one component of the total length of stay in the ED. In most hospitals, physicians must visit a computer terminal periodically, log in, refresh the data, and check on patients’ lab results.
The smartphone push alerts deliver the status of the results without the physician having to find the time to inquire.
“There is that lag of time when all the results are back and the patient is ready to be discharged, but the physician is busy doing other things and may not be aware that the results are ready and the patient is waiting for discharge,” she says. “Without sitting at a computer and constantly refreshing, there is going to be a lag time between when the results are sent and the physician realizes they are ready. Pushing that information to the smartphone makes the physician aware immediately, so that he or she can read the results and act on them at the first opportunity.”
The physician does not necessarily act on the results immediately when the push alert is received, but, at least, is aware much sooner that the information is available. In Verma’s research, physicians did act on the information more quickly than they would have without the push alerts.
The system at Sunnybrook Health Sciences Centre also pushes critical lab results to the smartphones in addition to the troponin levels.
Implementing a push alert system first requires overcoming concerns about patient privacy and HIPAA compliance, Verma notes. The hospital addressed those concerns by providing dedicated smartphones to the ED physicians for use only on the premises, with software that enables remote wiping of the phone data if they are lost or stolen.
The phones stay in the hospital and are not dedicated to individual physicians. The doctor signs out a phone at the beginning of the shift, which can be used in all the normal ways a smartphone is used, in addition to receiving the push alerts. They are loaded with useful apps for ED physicians and can be used for calling or receiving calls from other doctors for consultations.
“Getting the physicians to use the phones, instead of their own smartphones, can be an obstacle itself. But if you make sure it has all the apps they like, and maybe some they didn’t even know about before, they will be willing to use it when they see the benefit of the push alerts,” Verma says. “They also may see the push alerts as interruptions and they already have enough interruptions in their day, so they’re willing to just wait until they can get to a computer and look for the results.”
The physicians at Sunnybrook Health Sciences Centre are not required to use the smartphones, and some did decline at first. They became more willing to use the phones when they started seeing that it produces results in terms of discharge times, Verma says.
“It’s important to note that you don’t have to have 100% participation to see benefits from the push alerts,” Verma says. “There may be some physicians who just don’t want to receive the push alerts, but the overall time for discharge can still be reduced significantly even when a portion of the physicians use them.”
- Aikta Verma MD, MHSc, FRCPC, Director of Clinical Operations, Department of Emergency Services, Sunnybrook Health Sciences Centre, University of Toronto. Email: email@example.com.