Study: ER docs using smartphones to receive test results can discharge chest pain patients faster

By Heather Mack

Smartphones can make a lot of things faster, like getting a cab, ordering food or finding a date. But they can also shave down waiting time in a situation where every minute can feel like an eternity: getting out of the hospital.

Specifically, patients who came to the emergency room in the University of Toronto’s system with chest pain could spend nearly a half hour less waiting to be discharged if their doctor received lab results on their smartphone rather than on the hospital’s electronic health record system, a new study published in the journal Annals of Emergency Medicine found.

Normally, all patients who come to the emergency room with chest pain must have their blood drawn to test for troponin levels, which, if elevated, can indicate a heart attack. In the study population of 1,554 patients, the median time from result to discharge is nearly 80 minutes. Doctors were randomly selected to receive results on their smartphone (the intervention) versus those who relied on the customary electronic health record notifications via the hospital’s computer system. The control group of 551 patients waited more than 94 minutes to be discharged, whereas the smartphone group was out of the emergency room in 68.5 minutes.

“For patients waiting for lab results, 26 minutes is significant, even if the smartphone process did not shorten overall length of stay significantly,” lead author Dr. Aikta Verma said in a statement. “For many patients, waiting for lab results that determine if they stay in the hospital or go home is the hardest part of the ER visit. Physicians who received troponin results on their smartphones made the decision to discharge their patients with chest pain a median of 26 minutes faster than physicians without troponin push-alert notifications.”

As the authors point out, reducing wait times in the emergency room is an ongoing challenge, as prolonged stays in the ER are associated with an increased risk of death even for patients who are well enough to be discharged.  While the study didn’t find the total length of emergency department stays to change much, getting faster results from other tests via smartphones could perhaps bring the total time down someday.

“Our study demonstrated reduced time to discharge decision for chest pain patients by pushing troponin results to smartphones. However, there are many other results that could also be pushed: other critical laboratory results, radiology reports, vital signs, etc.,” the authors write.  “Future studies could evaluate a combination of these push alerts to determine whether it leads to improvement in length of stay in the broader group of ED patients.”

For now, the researchers recommend using the smartphone method to deliver troponin results, but did caution against using smartphones in the hospital without careful consideration.

“Discussions with physicians revealed that too many alerts can be problematic,” they write. “Thus, future studies should aim to elucidate the ideal number and type of alerts that would optimize use of the push-alert program.”