Chart Review Alert for Critical Laboratory Result Notification

Madison McClafferty

Delaware Technical Community College

NUR410-501

Nursing Informatics

Professor St. John

April 16, 2023

details regarding patients during their hospital stay. There is a new technology that has added an

update to certain Electronic Medical Records (EMRs) to allow a notification reviewing system

that specifically allows for patient critical lab test results to not be so easily missed. Prior to this

technology, a nurse would have to manually scan through the patient’s chart to read critical lab

test results. Current staffing shortages and working conditions in hospitals make it likely for

nurses to potentially miss these critical lab test results. However, implementation of this

technology would require a warning screen to pop up on the patient’s chart in the event that a

critical lab test result is generated. The use of this certain technology will essentially allow for

patients to get quick and timely care resulting in positive patient outcomes.

The problem with my hospital and many others current system is that these critical lab

test results are commonly missed. When they are missed, it causes a delay in care and depending

on the type of critical la test result, it can negatively affect the patient. Missing such important

lab results can lead to a worsening of patient condition or even death which is devastating over

something that can be so easily notified to the primary nurse. It is the primary nurses and even

the providers responsibility to see and treat a critical lab test result, but there is not always

allowable time to do so.

A 2020 study concluded that with increased timeliness of notifications due to the new

EMR technology, the notification time for when a critical lab test result decreased from six

minutes to less than one minute for many of the results (Li et al., 2019). Another conclusion from

this same study also showed that with busy nurses and providers, the total time from sample

collection to notification to patient treatment was 323 minutes and with a total time thing long

can cause negative patient outcomes (Li et al., 2019).

labs are drawn, if the test comes back as a “critical” result the lab will issue a phone call to the

unit regarding the critical results. The lab calls the front desk of the unit where the patient is

located and gives the critical lab test result to either the charge nurse, the unit clerk, or whoever

happens to answer the phone at the time. After the result is read, the laboratory technician makes

the staff do a read-back to see if they have the correct critical lab test result notification. The lab

does not call the primary nurse so many times they do not get the notification themselves until

the one who picked up the phone can.

The critical lab result can only be seen when the primary nurse physically goes into the

chart and reads the results under the “Results Review” tab in the Electronic Medical Record

(EMR). Now with just a phone call and a read-back, that still causes a lot of error. The lab will

only call the front desk of the unit and not the primary nurse themselves which causes late

notification and even an error in the correct reporting. According to a 2020 study, there has been

up to 3.5% of reported telephone errors when critical lab test results are notified which can

ultimately be dangerous to patient outcomes (Li et al., 2019). This showed that with the use of

this specific notification technology has optimized patient care and results notification.

Although many accreditation programs do require the laboratory to do a read-back for

those who are taking the phone call about the critical lab test result, to ensure that adverse events

do not occur hospitals should be adding extra safeguards such as the EMR notification reviewing

system. With the accreditation requirements, laboratory technicians are supposed to notify the

appropriate and responsible caregiver, more specifically the primary nurse, but that almost never

happens which can ultimately cause those unwanted adverse events. With laboratory notifying a

unit staff member or the critical result, the lab also will document who they gave the result to,
but that also comes with errors because they many times will only write the persons first name

which does not the exact person who was notified. With this current notification system, it can

cause a lot of negative patient outcomes.

The computerized notification system has been around since 2009 but many healthcare

systems have not utilized these systems and workflows for potentially budget reasons. Although,

many hospitals do not realize that without paying for this notification system can cause adverse

events from late treatment and these events can lead to patient harm that will cause the hospital

even more money. According to a study, this notification system is called the Hospital Clinical

Information System (HCIS). The way the HCIS works is that when a caregiver has certain

patients attached to their EMR, when a critical lab test results an alert message will come on the

EMR screen and will not go away until the caregiver presses the “review” button which confirms

that the notification was seen. This “review” button even will document that the caregiver has

seen and reviewed the critical lab test result which makes them responsible for seeing the result

(Piva et al., 2009).

results are notified. The workflow map begins with when the provider orders bloodwork for the

patient as this is what initiates the lab work results process. First, the patients blook work is

collected and then the collected labs are resulted. It is then questioned if the lab results were

missed by the primary RN. If the answer is a yes which in this case it is, then the RN misses the

lab result. Next, the lab test result was resulted in a critical lab test result. The lab then calls this

critical lab test result using the current phone notification process and the primary RN staff does

not get notified of the critical result since the EMR doesn’t notify caregivers. Then, without

proper notification time the patient will ultimately go without timely care for this critical lab

result which can result in negative patient outcomes and even death. With only using this phone

notification process, it is time consuming and can lead to adverse events for patients.

When a provider puts any orders in or discontinues orders, nurses get a notification and

must “review” and essentially “sign” that they saw these orders changes made. Reviewing orders

also puts the responsibility on the primary nurse that they saw these orders being changed, which

not only puts a safeguard on patient care, but allows for quick notification of these changes

rather than going through the chart. Without the use of this HCIS notification system, the critical

lab result notification time went to over an hour, with more than 50% of laboratory notification

not being successful and delaying patient treatment. Now with the integration of the computer

notification system, this notification time was down to only eleven minutes which makes a huge

difference in patient outcomes than the phone notification process (Piva et al., 2009). Not only

does this computer notification system allow for ample patient treatment, but it also allows for

the laboratory staff to spend more time performing these important tests and less on trying to

communicate these critical lab results to all of the different patients caregivers.
Workflow Map Part 2

In comparison to Workflow Map Part 1, it explains the current hospital notification

system for critical lab test results where Part 2 shows how the computer notification system

would alert the results. In Workflow Map Part 2, it also begins with the provider ordering the lab

work but when the critical lab results, the result is called to the unit but also given an alert

notification across the caregivers EMR. When this occurs, the primary RN is able to notify the

patient’s primary provider right away and the provider can order any needed treatment of the
critical result. With this quickly ordered treatment the patient can receive immediate care and

positive patient outcomes are the final results.

It would be quintessential to patient care if all hospitals, and specifically the hospital I am

employed at to update their system to use the HCIS to allow immediate notification of patient’s

critical lab test result. With this system, it essentially decreases any obstacles in reporting these

results to the primary caregivers which allows for proper treatment. The Joint Commission and

The National Patient Safety Goals requires critical lab test results to be communicated with

caregivers but again doesn’t require the computer notification system. The HCIS will allow

nurses to quickly see results and without it is detrimental to the patient and their care. There is

less blame not only on the charge nurses or those who receive the call but also the laboratory

technician who is required to make these calls who ultimately has the responsibility on their

backs. The HCIS has allowed for hospitals to increase their critical lab test results notifications

up to 78% which has improved caregivers’ abilities to give quality treatment to their patients and

has decreased patient adverse events by 50% (Lynn & Olson, 2020). With this notification and

reviewing system in place, it will allow for more efficient and effective care for the patients and

that is why I believe that all hospitals should implement this important and lifesaving feature.

Chart Review Alert for Critical Laboratory Result Notification Use Implementation Policy

I. PURPOSE: The purpose of this policy is to improve patient critical lab test result

notification to caregivers.
 II. POLICY: Hospitals will implement this computerized-notification system to their

Electronic Medication Record (EMR) for patient’s critical lab test results to notify and

alert caregivers in real time to decrease patient adverse events due to missed results.

III. PROCEDURE:

a. Provider orders needed lab work for patient.

b. Patient blood work is collected.

c. The collected lab work is resulted. The primary RN either sees the results when

searching through patient chart or they do not.

d. The lab results were critical. It was called to the nursing unit and there is also a

notification alert on the EMR for nurse to quickly see and review the critical lab

test result.

e. The primary RN can notify the patient’s primary provider as quickly as possible

since there was a real time notification alert on the EMR.

f. The patient’s primary provider orders appropriate treatment and/or medication to

treat patient’s critical lab test result.

g. The patient received immediate care which treated or helped to treat the critical

lab result.

h. In the end, the patient has positive health outcomes due to the immediate

notification of the critical lab test result. The patient avoids adverse health events.
 References

Li, R., Wang, T., Gong, L., Dong, J., Xiao, N., Yang, X., Zhu, D., & Zhao, Z. (2019). Enhance

the effectiveness of Clinical Laboratory Critical Values Initiative Notification by

implementing a closed‐loop system: A five‐year retrospective observational study. Journal

of Clinical Laboratory Analysis, 34(2). https://doi.org/10.1002/jcla.23038

Lynn, T. J., & Olson, J. E. (2020). Improving critical value notification through secure text

messaging. Journal of Pathology Informatics, 11(1), 21.

https://doi.org/10.4103/jpi.jpi_19_20

Piva, E., Sciacovelli, L., Zaninotto, M., Laposata, M., & Plebani, M. (2009, January 3). Enhance

the effectiveness of clinical laboratory critical values ... American Journal of Clinical

Pathology. Retrieved April 15, 2023, from

https://onlinelibrary.wiley.com/doi/full/10.1002/jcla.23038