title: Four-year impact of an alert notification system on closed-loop communication of critical test results.
abstract: OBJECTIVE
  One of the patient safety goals proposed by the Joint Commission urges hospitals to develop a policy for communicating critical test results and to measure adherence to that policy. We evaluated the impact of an alert notification system on policy adherence for communicating critical imaging test results to referring providers and assessed system adoption over the first 4 years after implementation.
  
  
  METHODS
  This study was performed in a 753-bed academic medical center. The intervention, an automated alert notification system for critical results, was implemented in January 2010. The primary outcome was adherence to institutional policy for timely closed-loop communication of critical imaging results, and the secondary outcome was system adoption. Policy adherence was determined through manual review of a random sample of radiology reports from the first 4 years after the intervention (n = 37,604) compared with baseline outcomes 1 year before the intervention (n = 9430). Adoption was evaluated by quantifying the use of the system overall and the proportion of alerts that used noninterruptive communication as a percentage of all reports generated by 320 radiologists (n = 1,538,059). A statistical analysis of the trend at 6-month intervals over 4 years was performed using a chi-square trend test.
  
  
  RESULTS
  Adherence to the policy increased from 91.3% before the intervention to 95.0% after the intervention (p < 0.0001). There was a ninefold increase in the critical results communicated via the system (chi-square trend test, p < 0.0001). During the first 4 years after the intervention, 41,445 alerts (41% of the total number of alerts) used the system's noninterruptive process for communicating less urgent critical results, which was substantially unchanged over the 4 years postintervention, thus reducing unnecessary paging interruptions.
  
  
  CONCLUSIONS
  An automated alert notification system for communicating critical imaging results was successfully adopted and was associated with increased adherence to institutional policy for communicating critical test results and with reduced workflow interruptions.
authors.affiliation: 1 Center for Evidence-Based Imaging, Brigham and Women's Hospital, 1620 Tremont St, 3rd Fl, Boston, MA 02120.
authors.forename: Ronilda
authors.initials: R
authors.lastname: Lacson
authors.forename: Luciano M
authors.initials: LM
authors.lastname: Prevedello
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Andriole
authors.forename: Stacy D
authors.initials: SD
authors.lastname: O'Connor
authors.forename: Christopher
authors.initials: C
authors.lastname: Roy
authors.forename: Tejal
authors.initials: T
authors.lastname: Gandhi
authors.forename: Anuj K
authors.initials: AK
authors.lastname: Dalal
authors.forename: Luke
authors.initials: L
authors.lastname: Sato
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D001900:Boston; D020000:Decision Support Systems, Clinical / Q000592:standards / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006747:Hospital Communication Systems / Q000592:standards* / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D011871:Radiology / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D014600:Utilization Review; D057188:Workflow; D016526:Workload / Q000706:statistics & numerical data*
keywords: alert notification; automated system; closed-loop communication; critical test results