Effect of a Laboratory Result Pager on Provider Behavior in a Neonatal Intensive Care Unit

Summary

Background: A computerized laboratory result paging system (LRPS) that alerts providers about abnormal results (“push”) may improve upon active laboratory result review (“pull”). However, implementing such a system in the intensive care setting may be hindered by low signal-to-noise ratio, which may lead to alert fatigue.

Objective: To evaluate the impact of an LRPS in a Neonatal Intensive Care Unit.

Methods: Utilizing paper chart review, we tallied provider orders following an abnormal laboratory result before and after implementation of an LRPS. Orders were compared with a predefined set of appropriate orders for such an abnormal result. The likelihood of a provider response in the post-implementation period as compared to the pre-implementation period was analyzed using logistic regression. The provider responses were analyzed using logistic regression to control for potential confounders.

Results: The likelihood of a provider response to an abnormal laboratory result did not change significantly after implementation of an LRPS. (Odds Ratio 0.90, 95% CI 0.63–1.30, p-value 0.58) However, when providers did respond to an alert, the type of response was different. The proportion of repeat laboratory tests increased. (26/378 vs. 7/278, p-value = 0.02)

Conclusion: Although the laboratory result pager altered healthcare provider behavior in the Neonatal Intensive Care Unit, it did not increase the overall likelihood of provider response.

 

MissingLinkText

Keywords

Medical informatics applications - reminder systems - clinical laboratory information systems - hospital communication systems - time factors

 

 

MissingLinkText

Conflicts of interest

The authors have no conflict of interest to disclose.

^* This work was done at Johns Hopkins Hospital, Baltimore, MD.

• References

• 1 Tate KE, Gardner RM, Weaver LK. A computerized laboratory alerting system. MD Comput 1990; 7 (05) 296-301.
• 2 Reddy MC, McDonald DW, Pratt W, Shabot MM. Technology, work, and information flows: Lessons from the implementation of a wireless alert pager system. J Biomed Inform 2005; 38 (03) 229-238.
• 3 Ezzie ME, Aberegg SK, O’Brien Jr. JM. Laboratory testing in the intensive care unit. Crit Care Clin 2007; 23 (03) 435-465.
• 4 Zimmerman JE, Seneff MG, Sun X, Wagner DP, Knaus WA. Evaluating laboratory usage in the intensive care unit: patient and institutional characteristics that influence frequency of blood sampling. Crit Care Med 1997; 25 (05) 737-748.
• 5 Kuperman GJ, Boyle D, Jha A, Rittenberg E, Ma’Luf N, Tanasijevic MJ. et. al. How promptly are inpatients treated for critical laboratory results?. J Am Med Inform Assoc 1998; 5 (01) 112-119.
• 6 Nosanchuk JS, Gottmann AW. CUMS and delta checks. A systematic approach to quality control. Am J Clin Pathol 1974; 62 (05) 707-712.
• 7 Palen TE, Raebel M, Lyons E, Magid DM. Evaluation of laboratory monitoring alerts within a computerized physician order entry system for medication orders. Am J Manag Care 2006; 12 (07) 389-395.
• 8 Rind DM, Safran C, Phillips RS, Wang Q, Calkins DR, Delbanco TL. et al. Effect of computer-based alerts on the treatment and outcomes of hospitalized patients. Arch Intern Med 1994; 154 (13) 1511-1517.
• 9 Kuperman GJ, Teich JM, Tanasijevic MJ, Ma’Luf N, Rittenberg E, Jha A. et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc 1999; 6 (06) 512-522.
• 10 Johnson DS, Ranzenberger J, Herbert RD, Gardner RM, Clemmer TP. A computerized alert program for acutely ill patients. J Nurs Adm 1980; 10 (06) 26-35.
• 11 Reddy MC, Pratt W, McDonald DW, Shabot MM. Challenges to physicians’ use of a wireless alert pager. AMIA Annu Symp Proc 2003: 544-548.
• 12 Stavroudis TA, Hemachandra AH, Lehmann CU. Who cares to know: defining neonatal critical laboratory values. Poster session presented at: American Academy of Pediatrics National Conference and Exhibition; 2007 Oct 27–30; San Francisco, CA.:
• 13 Poon EG, Kuperman GJ, Fiskio J, Bates DW. Real-time notification of laboratory data requested by users through alphanumeric pagers. J Am Med Inform Assoc 2002; 9 (03) 217-222.
• 14 Emancipator K. Critical values: ASCP practice parameter. American Society of Clinical Pathologists. Emancipator K. Critical values: ASCP practice parameter. American Society of Clinical Pathologists. Am J Clin Pathol 1997; 108 (03) 247-253.
• 15 Wagar EA, Stankovic AK, Wilkinson DS, Walsh M, Souers RJ. Assessment monitoring of laboratory critical values: a College of American Pathologists Q-Tracks study of 180 institutions. Arch Pathol Lab Med 2007; 131 (01) 44-49.