title: Effect of a laboratory result pager on provider behavior in a neonatal intensive care unit.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Internal Medicine and Primary Care, Brighman and Women's Hospital.
authors.forename: L
authors.initials: L
authors.lastname: Samal
authors.forename: Ta
authors.initials: T
authors.lastname: Stavroudis
authors.forename: Re
authors.initials: R
authors.lastname: Miller
authors.forename: Hp
authors.initials: H
authors.lastname: Lehmann
authors.forename: Cu
authors.initials: C
authors.lastname: Lehmann
keywords: Medical informatics applications; clinical laboratory information systems; hospital communication systems; reminder systems; time factors