What Factors Determine the Use of an Electronic Test Result Acknowledgement System? - A Qualitative Study Across Two EDs

Electronic medical record-based test results management interventions hold the potential to reduce errors in the test result follow-up process. However, ensuring the adaptability of such systems to the clinical environment has proven challenging. The aim of this study was to explore how contextual factors can influence senior emergency physicians' experience and perceived impacts of an electronic result acknowledgement system across two Emergency Departments. Semi-structured, in-depth interviews relating to physician test result acknowledgement processes before and after system implementation were conducted with 14 senior Emergency Physicians across two Australian metropolitan teaching hospitals. Perceived impacts of the electronic test result acknowledgement system on test result endorsement varied in terms of: changes to workflow, impacts on patient safety; and changes to documentation practices. Existing work practices and the departmental staffing mix and roles play a part in determining the nature of change that an electronic result acknowledgement system is likely to produce.

[1]  Ramin Khorasani,et al.  An initiative to improve the management of clinically significant test results in a large health care network. , 2013, Joint Commission journal on quality and patient safety.

[2]  David W Bates,et al.  Mixed results in the safety performance of computerized physician order entry. , 2010, Health affairs.

[3]  Andrew Georgiou,et al.  Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers’ hospital , 2014, J. Am. Medical Informatics Assoc..

[4]  Pierre Lewalle,et al.  Towards an International Classification for Patient Safety: the conceptual framework , 2009, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[5]  Anuj K. Dalal,et al.  Lessons learned from implementation of a computerized application for pending tests at hospital discharge. , 2011, Journal of hospital medicine.

[6]  David W Bates,et al.  Can electronic clinical documentation help prevent diagnostic errors? , 2010, The New England journal of medicine.

[7]  Andrew Georgiou,et al.  The safety implications of missed test results for hospitalised patients: a systematic review , 2011, Quality and Safety in Health Care.

[8]  Michael W. Smith,et al.  Primary care practitioners’ views on test result management in EHR-enabled health systems: a national survey , 2012, J. Am. Medical Informatics Assoc..

[9]  Dean F Sittig,et al.  A new sociotechnical model for studying health information technology in complex adaptive healthcare systems , 2010, Quality and Safety in Health Care.

[10]  Simran Singh,et al.  Understanding the management of electronic test result notifications in the outpatient setting , 2011, BMC Medical Informatics Decis. Mak..

[11]  Marc Berg,et al.  Patient care information systems and health care work: a sociotechnical approach , 1999, Int. J. Medical Informatics.

[12]  Andrew Georgiou,et al.  Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review , 2011, Journal of General Internal Medicine.

[13]  Hardeep Singh,et al.  Research paper: Provider management strategies of abnormal test result alerts: a cognitive task analysis , 2010, J. Am. Medical Informatics Assoc..

[14]  A. Sayer.  Method in Social Science: Revised 2nd Edition , 2010 .

[15]  Dean F Sittig,et al.  How context affects electronic health record-based test result follow-up: a mixed-methods evaluation , 2014, BMJ Open.

[16]  Andrew Georgiou,et al.  A qualitative analysis of Emergency Department physicians' practices and perceptions in relation to test result follow-up , 2010, MedInfo.

[17]  P. Cram,et al.  Failure to Recognize Newly Identified Aortic Dilations in a Health Care System With an Advanced Electronic Medical Record , 2009, Annals of Internal Medicine.