Implementation and Evaluation of an Automated Email Notification System for Results of Tests Pending at Discharge - Final Report

Purpose: We developed an automated email notification system to prompt physicians of results of tests pending at discharge (TPADs) and evaluated its impact on physician awareness. Scope: Physician awareness of the results of TPADs is generally poor. We designed and implemented an automated email notification system to prompt responsible providers of these results during a patient’s transition from the inpatient to ambulatory setting. We activated this system for patients discharged from the inpatient general medicine and cardiology services at Brigham and Women’s Hospital in order to evaluate its impact on physician awareness of TPAD results of any type (chemistry, hematology, radiology, pathology, or microbiology). Methods: We conducted a cluster-randomized controlled trial in which both the inpatient attending and primary care provider (PCP) were randomized to the automated email notification system (intervention) or usual care for any patient discharged with TPADs during an 8 month study period. We surveyed these physicians with regard to awareness of any TPAD result, awareness of actionable TPAD results, and satisfaction. Results: We enrolled a total of 441 patients. Inpatient attendings and PCPs caring for these patients were significantly more aware of any TPAD result (chemistry, hematology, radiology, pathology, or microbiology) in the automated e-mail notification compared to usual care arm (Inpatient Attending Awareness 76% vs. 38%, p < .0001, PCP Awareness 57% vs. 33%, p=0.003). Inpatient attendings were significantly more aware of actionable TPAD results in the intervention compared to usual care arms (59% vs. 29%, p=0.02). Eighty-nine percent and 70% of intervention inpatient attendings and PCPs were satisfied with automated email notification of TPAD results, respectively.