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Health Informatics Unit
The University of Adelaide
SA 5005 Australia
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An Investigation Result Alerting System for Community Acquired Pneumonia (CAP) patients in the Emergency Department

Scott Clark

Health Informatics, University of Adelaide

Recent evidence indicates that many results available in the Emergency department via computer reporting systems are not viewed in a timely fashion. Kilpatrick et al. [1] found that 15 % of results were not viewed within 3 hours of posting and 45% percent of results were never accessed at all. Utilizing potassium and amylase as indicators of critical illness, the authors found that 3% of the results never accessed would have resulted in immediate changes in management.

Evidence from a clinical trial indicates that test result alerting systems reduce the mean time to appropriate medical intervention by 38% [2] . Reminder systems have been shown to significantly improve physician performance [3] .

Preliminary CAP workflow assessment at a teaching hospital Emergency Department indicates that potential risk exists in the timeliness of reviewing important test and radiology results. Our studies indicated that assessment of x-ray and test results is carried out prior to the prescription of antibiotics, and that delay in viewing these results leads to delay in treatment. Delay to antibiotic treatment of patients with CAP is associated with poor outcomes [4] .

We plan to design and implement an alerting system for the investigation results of CAP patients in the Emergency Department at the teaching hospital. This system will use local clinical rules to filter and prioritise alerts.

References

1. Kilpatrick ES, Holding S. Use of computer terminals on wards to access emergency test results: a retrospective audit. Bmj 2001;322(7294):1101-3.

2. Kuperman GJ, Teich JM, Tanasijevic MJ, Ma'Luf N, Rittenberg E, Jha A, et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc 1999;6(6):512-22.

3. Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998;280(15):1339-46.

4. Meehan TP, Fine MJ, Krumholz HM, Scinto JD, Galusha DH, Mockalis JT, et al. Quality of care, process, and outcomes in elderly patients with pneumonia [see comments]. Jama 1997;278(23):2080-4.