title: What is the impact of an electronic test result acknowledgement system on Emergency Department physicians' work processes? A mixed-method pre-post observational study.
abstract: To examine the impact of an electronic Results Acknowledgement (eRA) system on emergency physicians' test result management work processes and the time taken to acknowledge microbiology and radiology test results for patients discharged from an Emergency Department (ED).
  
  
  
  The impact of the eRA system was assessed in an Australian ED using: a) semi-structured interviews with senior emergency physicians; and b) a time and motion direct observational study of senior emergency physicians completing test acknowledgment pre and post the implementation of the eRA system.
  
  
  
  The eRA system led to changes in the way results and actions were collated, stored, documented and communicated. Although there was a non-significant increase in the average time taken to acknowledge results in the post period, most types of acknowledgements (other than simple acknowledgements) took less time to complete. The number of acknowledgements where physicians sought additional information from the Electronic Medical Record (EMR) rose from 12% pre to 20% post implementation of eRA.
  
  
  
  Given that the type of results are unlikely to have changed significantly across the pre and post implementation periods, the increase in the time physicians spent accessing additional clinical information in the post period likely reflects the greater access to clinical information provided by the integrated electronic system. Easier access to clinical information may improve clinical decision making and enhance the quality of patient care. For instance, in situations where a senior clinician, not initially involved in the care process, is required to deal with the follow-up of non-normal results.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. Electronic address: andrew.georgiou@mq.edu.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Euan J
authors.initials: EJ
authors.lastname: McCaughey
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
authors.forename: Amina
authors.initials: A
authors.lastname: Tariq
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Walter
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Li
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Callen
authors.affiliation: Emergency Department, Concord Repatriation General Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Paoloni
authors.affiliation: Centre for Population Health Research, School of Health Sciences, The University of South Australia, Adelaide, Australia; Macquarie University, Sydney, Australia; The Joanna Briggs Institute, Department of Anaesthesia and Intensive Care, University of Adelaide, Adelaide, Australia; Australian Patient Safety Foundation, Adelaide, Australia.
authors.forename: William B
authors.initials: WB
authors.lastname: Runciman
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
authors.forename: Johanna I
authors.initials: JI
authors.lastname: Westbrook
mesh_terms: D001315:Australia; D003266:Continuity of Patient Care / Q000592:standards*; D020000:Decision Support Systems, Clinical; D003955:Diagnostic Tests, Routine; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D010351:Patient Discharge; D010818:Practice Patterns, Physicians'; D011871:Radiology
keywords: Emergency Department; Information systems; Laboratory; Medical imaging; Test result follow-up