title: Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial.
abstract: OBJECTIVE
  Physician awareness of the results of tests pending at discharge (TPADs) is poor. We developed an automated system that notifies responsible physicians of TPAD results via secure, network email. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results.
  
  
  METHODS
  We conducted a cluster-randomized controlled trial at a major hospital affiliated with an integrated healthcare delivery network in Boston, Massachusetts. Adult patients with TPADs who were discharged from inpatient general medicine and cardiology services were assigned to the intervention or usual care arm if their inpatient attending physician and primary care physician (PCP) were both randomized to the same study arm. Patients of physicians randomized to discordant study arms were excluded. We surveyed these physicians 72 h after all TPAD results were finalized. The primary outcome was awareness of TPAD results by attending physicians. Secondary outcomes included awareness of TPAD results by PCPs, awareness of actionable TPAD results, and provider satisfaction.
  
  
  RESULTS
  We analyzed data on 441 patients. We sent 441 surveys to attending physicians and 353 surveys to PCPs and received 275 and 152 responses from 83 different attending physicians and 112 different PCPs, respectively (attending physician survey response rate of 63%). Intervention attending physicians and PCPs were significantly more aware of TPAD results (76% vs 38%, adjusted/clustered OR 6.30 (95% CI 3.02 to 13.16), p<0.001; 57% vs 33%, adjusted/clustered OR 3.08 (95% CI 1.43 to 6.66), p=0.004, respectively). Intervention attending physicians tended to be more aware of actionable TPAD results (59% vs 29%, adjusted/clustered OR 4.25 (0.65, 27.85), p=0.13). One hundred and eighteen (85%) and 43 (63%) intervention attending physician and PCP survey respondents, respectively, were satisfied with this intervention.
  
  
  CONCLUSIONS
  Automated email notification represents a promising strategy for managing TPAD results, potentially mitigating an unresolved patient safety concern.
  
  
  BACKGROUND
  ClinicalTrials.gov (NCT01153451).
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Anuj K
authors.initials: AK
authors.lastname: Dalal
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Roy
authors.forename: Eric G
authors.initials: EG
authors.lastname: Poon
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Williams
authors.forename: Nyryan
authors.initials: N
authors.lastname: Nolido
authors.forename: Cathy
authors.initials: C
authors.lastname: Yoon
authors.forename: Jonas
authors.initials: J
authors.lastname: Budris
authors.forename: Tejal
authors.initials: T
authors.lastname: Gandhi
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection; D019033:Delivery of Health Care, Integrated; D003955:Diagnostic Tests, Routine / Q000592:standards; D034742:Electronic Mail; D006801:Humans; D008505:Medical Staff, Hospital; D010351:Patient Discharge; D061214:Patient Safety; D058007:Physicians, Primary Care
keywords: Tests pending at discharge; automated email notification; care transitions