Four-year impact of an alert notification system on closed-loop communication of critical test results

Abstract

Objective: One of the patient safety goals proposed by the Joint Commission urges hospitals to develop a policy for communicating critical test results and to measure adherence to that policy. We evaluated the impact of an alert notification system on policy adherence for communicating critical imaging test results to referring providers and assessed system adoption over the first 4 years after implementation.

Materials and methods: This study was performed in a 753-bed academic medical center. The intervention, an automated alert notification system for critical results, was implemented in January 2010. The primary outcome was adherence to institutional policy for timely closed-loop communication of critical imaging results, and the secondary outcome was system adoption. Policy adherence was determined through manual review of a random sample of radiology reports from the first 4 years after the intervention (n = 37,604) compared with baseline outcomes 1 year before the intervention (n = 9430). Adoption was evaluated by quantifying the use of the system overall and the proportion of alerts that used noninterruptive communication as a percentage of all reports generated by 320 radiologists (n = 1,538,059). A statistical analysis of the trend at 6-month intervals over 4 years was performed using a chi-square trend test.

Results: Adherence to the policy increased from 91.3% before the intervention to 95.0% after the intervention (p < 0.0001). There was a ninefold increase in the critical results communicated via the system (chi-square trend test, p < 0.0001). During the first 4 years after the intervention, 41,445 alerts (41% of the total number of alerts) used the system's noninterruptive process for communicating less urgent critical results, which was substantially unchanged over the 4 years postintervention, thus reducing unnecessary paging interruptions.

Conclusion: An automated alert notification system for communicating critical imaging results was successfully adopted and was associated with increased adherence to institutional policy for communicating critical test results and with reduced workflow interruptions.

Keywords: alert notification; automated system; closed-loop communication; critical test results.

Fig. 1

Adoption of Alert Notification of Critical Results (ANCR) system over first 4 years after implementation. Jan = January, Dec = December. A and B, Graphs show proportion of radiology reports in which ANCR was used to communicate critical results as compared with radiology reports with documented communication (A) and as compared with all radiology reports (B).

Fig. 2

Bar graph shows mode of communication for yellow-level alerts communicated using Alert Notification of Critical Results (ANCR) system over first 4 years after implementation. Yellow-level alert is defined as result that is not immediately life-threatening or urgent. Communication of yellow alerts may be asynchronous and noninterruptive, but documentation of closed-loop communication is still required.