Comparison of warfarin therapy clinical outcomes following implementation of an automated mobile phone-based critical laboratory value text alert system
Journal
BMC Medical Genomics
Journal Volume
7
Journal Issue
SUPPL.1
Pages
S13
Date Issued
2014
Author(s)
Abstract
Background: Computerized alert and reminder systems have been widely accepted and applied to various patient care settings, with increasing numbers of clinical laboratories communicating critical laboratory test values to professionals via either manual notification or automated alerting systems/computerized reminders. Warfarin, an oral anticoagulant, exhibits narrow therapeutic range between treatment response and adverse events. It requires close monitoring of prothrombin time (PT)/international normalized ratio (INR) to ensure patient safety. This study was aimed to evaluate clinical outcomes of patients on warfarin therapy following implementation of a Personal Handy-phone System-based (PHS) alert system capable of generating and delivering text messages to communicate critical PT/INR laboratory results to practitioners' mobile phones in a large tertiary teaching hospital. Methods. A retrospective analysis was performed comparing patient clinical outcomes and physician prescribing behavior following conversion from a manual laboratory result alert system to an automated system. Clinical outcomes and practitioner responses to both alert systems were compared. Complications to warfarin therapy, warfarin utilization, and PT/INR results were evaluated for both systems, as well as clinician time to read alert messages, time to warfarin therapy modification, and monitoring frequency. Results: No significant differences were detected in major hemorrhage and thromboembolism, warfarin prescribing patterns, PT/INR results, warfarin therapy modification, or monitoring frequency following implementation of the PHS text alert system. In both study periods, approximately 80% of critical results led to warfarin discontinuation or dose reduction. Senior physicians' follow-up response time to critical results was significantly decreased in the PHS alert study period (46.3% responded within 1 day) compared to the manual notification study period (24.7%; P = 0.015). No difference in follow-up response time was detected for junior physicians. Conclusions: Implementation of an automated PHS-based text alert system did not adversely impact clinical or safety outcomes of patients on warfarin therapy. Approximately 80% immediate recognition of text alerts was achieved. The potential benefits of an automated PHS alert for senior physicians were demonstrated. ? 2014 Lin et al.; licensee BioMed Central Ltd.
SDGs
Other Subjects
warfarin; anticoagulant agent; warfarin; adult; aged; anticoagulation; article; bleeding; computer system; controlled study; electronic medical record; female; follow up; human; international normalized ratio; interpersonal communication; major clinical study; male; middle aged; outcome assessment; patient monitoring; patient safety; Personal Handy phone System based alert system; priority journal; prothrombin time; recognition; retrospective study; seasonal variation; sex difference; tertiary health care; thromboembolism; very elderly; young adult; automation; bleeding; chemically induced; comparative study; diagnostic procedure; dose calculation; drug monitoring; health personnel attitude; physician; prescription; psychology; reminder system; statistics and numerical data; teaching hospital; text messaging; treatment outcome; Adult; Aged; Aged, 80 and over; Anticoagulants; Attitude of Health Personnel; Automation; Clinical Laboratory Techniques; Drug Dosage Calculations; Drug Monitoring; Drug Prescriptions; Hemorrhage; Hospitals, Teaching; Humans; Male; Middle Aged; Patient Safety; Physicians; Prothrombin Time; Reminder Systems; Retrospective Studies; Text Messaging; Treatment Outcome; Warfarin; Young Adult
Type
journal article