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Appl Clin Inform 2011; 02(03): 384-394
DOI: 10.4338/ACI-2010-09-RA-0052
Research Article
Schattauer GmbH

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

L. Samal
1   Division of General Internal Medicine and Primary Care, Brighman and Women‘s Hospital
,
TA. Stavroudis
2   Division of Newborn and Critical Care, Children’s Hospital of Los Angeles
,
RE. Miller
3   Department of Pathology, Johns Hopkins University School of Medicine
,
HP. Lehmann
4   Division of Health Sciences Informatics, Johns Hopkins University School of Medicine
,
CU. Lehmann   *
5   Division of Neonatal-Perinatal Medicine, Johns Hopkins University School of Medicine
› Author Affiliations
Further Information

Publication History

received: 07 September 2011

accepted: 16 March 2011

Publication Date:
16 December 2017 (online)

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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.

Keywords

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

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


 

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