Push notifications for critical labs results: a pilot study in the intensive care unit (ICU)

Lay Summary The increased use and adoption of electronic health records afford the opportunity to enhance and improve efficiency in the delivery of care. One such efficiency, which also offers a patient safety opportunity, is the use of "push" notifications that alert frontline staff on critical lab results that need urgent action. In this study, we integrated such a feature as part of the electronic health record in the intensive care unit of a large urban academic health center. Prior to this intervention, our clinical laboratory service technicians were paging/calling critical labs resulting in high turnaround times and potentially delayed patient care. We developed an electronic workflow for pushing critical lab notifications to providers (mostly residents) for 3 months in the medical intensive care units. We found that the frontline staff acknowledged about 6% of results using the push notification. Although the acknowledgment rate was low, this translated into fewer manual pages/phone calls to our lab service technicians. As familiarity with technology and workflow increases, this novel approach can improve communication, have significant cost savings for lab services, and improve efficiency with the goal of keeping patients safe in the hospital. Objective We developed a push notification allowing for an electronic acknowledgment of critical lab results to providers in the intensive care unit. Materials and Methods This project was conducted over a 3-month period at a large academic safety net hospital. A push notification and acknowledgment system were created to comply with the existing critical results notification requirements. We monitored the number of acknowledged results, time to acknowledgment, and lab type. Results Prior to the push notification, lab services paged the provider. This resulted in many critical lab results relayed to the clinician beyond the expected 10-minute window. With the push notification workflow, we found that, during the 3-month period, 82, or 5.8%, of the 1414 results were acknowledged. This represented 82 less pages/calls lab services had to make. Discussion The push notification alert was easy to use and there was quicker results notification when acknowledged. There were limitations due to hand-offs for clinicians and some were not familiar with the mobile technology and the electronic acknowledgment. Conclusions Although the acknowledgment rate was low, every electronic acknowledgment saved lab service technicians an average of 10 minutes compared to the existing workflow. As familiarity with the technology and workflow increases, this novel form of communication has the potential to have significant cost savings for lab services, in addition to efficiency gains for lab, clinicians, and more timely care. The integration of health information technology and push notification of critical labs should be the focus of investigation for further future research.