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Editor's Correspondence
February 22, 2010

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

Author Affiliations

Author Affiliations: Department of Medicine, Section of Medical Informatics (Drs Tenner and Shapiro), and Department of Quality Management (Dr Wikler), Department of Veterans Affairs, New York Harbor Healthcare System, New York, New York.

Arch Intern Med. 2010;170(4):392. doi:10.1001/archinternmed.2010.9

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.

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