Smartphones enable ER doctors to discharge patients quicker

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Sending laboratory results to emergency room physicians’ smartphones as soon as they are available can significantly hasten discharge decisions for chest pain patients.

That’s the conclusion of a randomized controlled trial that assessed the effect of using push alerts to doctor’s smartphones for lab results. The study was published online last week in Annals of Emergency Medicine, the peer-reviewed scientific journal for the American College of Emergency Physicians.

“One factor contributing to ED length of stay is the turnaround time for laboratory test results,” state the authors. “However, even (after) laboratory tests are completed and results posted (in the electronic health record system), physicians may not immediately act on these results because they are performing other tasks, or because they are simply not aware that the results are available.”

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In the case of patients who come to an emergency department complaining of chest pain, a blood test is routinely conducted to test for troponin levels which—if elevated—indicate a heart attack.

The study conducted at Toronto’s Sunnybrook Health Sciences Centre found that doctors who received smartphone push-alert notifications of troponin results discharged their patients with chest pain 26 minutes faster than those without such notifications. At the same time, the total length of stay in the ED did not significantly improve for these patients.

“For patients waiting for lab results, 26 minutes is significant, even if the smartphone process did not shorten overall length of stay significantly,” said study author Aikta Verma, MD, in the Department of Medicine, Division of Emergency Medicine, at the University of Toronto. “For many patients, waiting for lab results that determine if they stay in the hospital or go home is the hardest part of the ER visit.”

As Verma and her co-authors note, the time between when the laboratory result is available and when the doctor actually reviews it is an important opportunity for improving ER efficiency.

In fact, she contends that there are many other critical lab results, such as radiology reports, that could also enhance care if they are pushed to physicians’ smartphones. “For now, we recommend the use of the push-alert notification system to improve flow through the emergency department for chest pain patients,” advises Verma.

“It’s wonderful, cutting-edge research in an outstanding publication,” says Jon Hirshon, MD, professor in the Department of Emergency Medicine and in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine. “It’s very nice to see ways that we can improve the efficiency of the emergency department while maintaining high quality care.”

Hirshon, who also sits on the American College of Emergency Physicians board of directors and serves as liaison to the informatics section, contends that the major benefit of smartphones in the ER is that they can substantially improve the workflow by decreasing the individual time for treating patients.

“It’s really the difference between a push system and pull system. If I have to go grab test results myself, there will be more delays than a system that automatically notifies me on my smartphone,” he adds. “We have to be aware of the utilization of new tools and apps to see how best to apply them. Many aspects of using electronic health records have been a challenge, so it’s wonderful to be able to leverage mobile technology and provide more efficient care to patients.”

While Hirshon acknowledges that doctors’ smartphones are at risk from cybersecurity threats, he believes mobile devices can be sufficiently secured from hacker activity. “Security is clearly paramount and making sure that patients’ medical information is not hacked.”

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