Design and implementation of an automated email notification system for results of tests pending at discharge

Abstract

Physicians are often unaware of the results of tests pending at discharge (TPADs). The authors designed and implemented an automated system to notify the responsible inpatient physician of the finalized results of TPADs using secure, network email. The system coordinates a series of electronic events triggered by the discharge time stamp and sends an email to the identified discharging attending physician once finalized results are available. A carbon copy is sent to the primary care physicians in order to facilitate communication and the subsequent transfer of responsibility. Logic was incorporated to suppress selected tests and to limit notification volume. The system was activated for patients with TPADs discharged by randomly selected inpatient-attending physicians during a 6-month pilot. They received approximately 1.6 email notifications per discharged patient with TPADs. Eighty-four per cent of inpatient-attending physicians receiving automated email notifications stated that they were satisfied with the system in a brief survey (59% survey response rate). Automated email notification is a useful strategy for managing results of TPADs.

Figure 1

Overview of system. The system coordinates a sequence of electronic events initiated by the discharge time entered by the unit clerk and culminating in automated email notifications to the identified providers. For any discharged patient with tests pending at discharge (TPADs), providers receive no more than one email per notification type per day.

Figure 2

Example of a chemistry/hematology email notification. All emails are addressed to the responsible inpatient attending and states whether a carbon copy was sent to the primary care provider (PCP). All emails specify the date the email was sent, identifies the patient (name, discharge date, Brigham and Women's Hospital (BWH) medical record number). Finalized test results appear at the top and pending tests appear at the bottom. Abnormal results are highlighted. For this patient, Dr Hospitalist received a total of three chemistry/hematology emails on three separate days (the first email is shown here).

Figure 3

Email notifications sent to providers of 95 discharged patients with all tests pending at discharge (TPADs) finalized. The majority of emails are of the microbiology notification type. For patients with a non-network primary care physician (PCP) (or no identified PCP), the inpatient-attending physician alone receives the alert. Chem, chemistry; Heme, hematology; Micro, microbiology; Path, pathology; Rad, radiology.