Push Alert Labs - ICYMI Troponin Is Positive

Spoon Feed
Push alerts for troponin results to a physician's smartphone decreased time to disposition by 26 minutes, but it didn't significantly affect total length of stay.  For those like me, who thought ICYMI was a trial acronym for therapeutic hypothermia, it stands for "in case you missed it" in text lingo. Yeah, I'm that hip...

Why does this matter?
Making a dent in ED lengths of stay means more rooms are available to see new patients.  The most dangerous place in any ED is the waiting room.  One potential impediment to making a disposition decision is obtaining test results.  Currently, we have to actively look for test results.  In the busyness of the ED, sometimes results are back for quite a long time before we think to check them.  Rather than going after information, this study turned it around and made the information flow to the clinician.  This has potential, but the overall impact was small here.

Smartphone alert, "Troponin bed B29 is 0.26"
This was a non-blinded cluster randomized trial of 26 physicians, 1105 patients, with some receiving smartphone alerts for troponin results and some not.  They found that those who received alerts were quicker in time to disposition by 26 minutes.  But the overall length of ED stay was only 17 minutes shorter, and that was not statistically significant.  This was a single center study, and there was no way to know if physicians actually read the alerts, which would have strengthened the study design.  My experience with push-radiology alerts at our institution has been favorable, N = 1.

Source
Push-Alert Notification of Troponin Results to Physician Smartphones Reduces the Time to Discharge Emergency Department Patients: A Randomized Controlled Trial.  Ann Emerg Med. 2017 Sep;70(3):348-356. doi: 10.1016/j.annemergmed.2017.03.021. Epub 2017 May 9.

Another Spoonful
EM Lit of Note liked this study and wrote about it on his blog.

Peer reviewed by Thomas Davis, MD.

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