0
Editor's Correspondence |

Improving Health Care Provider Notification in an Academic Setting: A Cascading System of Alerts

Craig T. Tenner, MD; Neil M. Shapiro, MD; Alan Wikler, PsyD
Arch Intern Med. 2010;170(4):392. doi:10.1001/archinternmed.2010.9.
Text Size: A A A
Published online

Extract

We applaud Singh and colleagues1 for their study “Timely Follow-up of Abnormal Diagnostic Tests Results in an Outpatient Setting: Are Electronic Medical Records Achieving Their Potential?” Like the authors, we also work at a tertiary Department of Veterans Affairs medical center with the same electronic medical record system and are affiliated with a large academic residency program. The issue of timely follow-up of abnormal test results has been of major concern at our facility, especially by house officers, who spend various amounts of time at our hospital. Frequently, the house officer who places an order is not stationed at our hospital when the results become available. To address this problem, we have developed a cascading system of notifications to improve the timeliness of health care provider notification.2 All residents are now assigned an attending surrogate who becomes the recipient of electronic test results that have not been acknowledged by the ordering resident in a timely manner. The surrogate is more aptly able to arrange necessary follow-up of test results and notifies the resident accordingly. If a surrogate becomes unavailable, the results can be forwarded to a higher-level supervisor for acknowledgment, generating a system of cascading notifications. Based on the type of result, we have designated limits to how long a test result can remain unacknowledged before being forwarded to the surrogate. Noncritical laboratory values are forwarded if unprocessed in 72 hours. It is important to emphasize that critical values are handled in a different manner. Although an electronic alert is sent, critical values are also called by the laboratory directly to a physician with verbal confirmation of the abnormality (with a “write down/read back policy”). Although this cascade system does not entirely eliminate the problem of timely follow-up, it has markedly improved the process since its inception.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Infection Prevention in the Emergency Department. Ann Emerg Med Published online Apr 8, 2014.;
Jobs
JAMAevidence.com
brightcove.createExperiences();