Push-Alerts of Lab Results Speeds Discharge from Emergency Dept

Smartphone push-alert notification of troponin laboratory results allow physicians to discharge patients seen in the emergency department for chest pain sooner, compared to physicians who do not receive push alerts, according to a study published online May 9 in the Annals of Emergency Medicine. While the difference in time to discharge was just under 30 minutes, the authors say this is enough to improve patient flow in the emergency department.

Emergency department throughput is an important quality indicator. Waiting for laboratory results has been cited as a contributor to patients’ length of stays in the emergency department.

In the present study participating physicians were randomized to receive troponin push alerts or not receive them (control). All patients who were treated by a participating physician during the study period (Feb. 1, 2014, to Oct. 15, 2014) and were discharged from the emergency department with a final diagnosis of chest pain were included. Chest pain discharges were chosen because the troponin would likely be the most important determinant of time to discharge. Participating physicians were not blinded to group assignment, as those assigned to the standard-of-care (no push alerts) needed to look up results on the computer.

The researchers found that over the study period, 1,554 patients were discharged from the emergency department with chest pain and of these 551 patients were part of the control group and 554 were in the intervention group.

The overall median interval from final troponin result to discharge decision was 79.7 minutes—94.3 minutes in the control group and 68.5 minutes in the intervention group. This 25.8-minute difference in medians was statistically significant. However, the total emergency department length of stay did not differ significantly between the groups.

“We believe there is clinical significance to 26 minutes, but there is a lack of evidence to guide what improvement in the time to make clinical decisions, or what improvement in total length of stay, should be considered clinically important,” write the authors led by Aikta Verma, M.D., from the University of Toronto in Canada. “This will likely vary among institutions according to factors such as current length of stay and target length of stay … The value of this intervention will depend on the costs and effects of other interventions available to each institution to improve length of stay.”