ADT Event Alerting
When a patient is admitted to a hospital, the patient's attending
physician must be correctly identified in the registration system.
Getting this wrong creates rework, which has an adverse effect on
both quality and cost of care. But our registration staff had no
way to confirm that they were being given the correct attending
when the patient was admitted. We needed a feedback loop to immediately
correct any mistakes.
Most of the errors occurred with patients admitted through the emergency
department (ED). This is predictable, because it can be difficult
for the ED to verify who should be the attending for a particular
patient, and ED physicians are under tremendous time pressure.
first question was: "Who really knows whether the attending
who was identified for a patient is actually the correct physician?"
The answer was easy. Whomever is currently listed as attending will
always know if they are NOT the attending for that patient, even
if they don't know who IS the correct attending. So we needed a
way for that person to confirm whether they were correctly assigned.
The first step was to get the data about admissions as they occurred.
We were already assembling data on a daily basis in the data
warehouse, but we needed to know about admissions as near to
real-time as possible.
began working on an automated process to pull all Admission / Discharge
/ Transfer (ADT) events from the Meditech system on a continuous
NPR report (Meditech's proprietary reporting system) extracts
all recent ADT events to a file. These include:
day care (SDC) admission
between rooms, units, clinical services, or attending physicians
(inpatient, SDC, ED)
contents of the file are used to update a database, where any
new or updated records are flagged for action.
process runs in a continuous loop, with a cycle time of 10-15 minutes.
This means that we know about any ADT event within 10-15 minutes
of its being input to Meditech by the registration staff.
Using the ADT data, we created an automated process to send e-mail
alerts to the attending physician and the patient's primary care
provider (PCP). This automated process serves as a supplement to
the regular clinician-to-clinician communication when patients:
admitted into or discharged from an emergency department;
admitted to an inpatient service;
transferred from one location to another;
transferred from one service to another;
transferred from one attending or PCP to another; or,
process also provides an opportunity to quickly correct erroneous
PCP and Attending assignments, and to gather information to help
improve sign-out processes.
does ADT Event Notification work?
clinicians receive e-mail notification via Outlook for any ED
visit or inpatient admission, transfer or discharge when they
are listed in Meditech as the PCP or the attending physician for
e-mails are sent within 10 minutes of the event being recorded
e-mails will have a subject line beginning with "ADT Alert"
for easy sorting and filing within Outlook (sample below).
may "opt in"to be notified by pager of any or all of
the above events.
options may be set differently for any combination of event type,
role, and paging option (shown below).
options may be changed for a specified period of time, and will
automatically revert to that clinician's "normal" settings
at the end of the period.
this service uses the Xtend paging system, if a pager is forwarded
or set to "Not Pageable" in Xtend, any ADT Event notification
pages will also be forwarded or blocked, per the settings in Xtend.
Attending/PCP assignment corrections
alert includes e-mail link to notify relevant admitting department
newly-assigned attending or PCP will receive alerts as described
Each physician can view, in the intranet data portal, a list of
all ED visits and inpatient admissions and discharges for which
that physician was listed as attending or PCP during the past 30
days. These reports are currently as follows:
Visits Month to date
Visits Last Month
Month to date - attending
Last Month - attending
Month to date - PCP
Last Month - PCP
ADT data month to date - attending
ADT data last month - attending
ADT data month to date - PCP
ADT data last month - PCP
inpatient list (e-mailed daily, shown below)
Acrobat document containing samples of all e-mailed alerts is available
for download (1MB download).
Physicians loved this process. It has some huge benefits for them,
know immediately when a patient for whom they are responsible
has been admitted or transferred, and can ensure that care is
can immediately correct any mistakes with assignments as attending
or PCP, and help ensure that the correct physician is assigned.
Again, this helps ensure coordination of care.
have a daily list of patients for rounding or follow-up.
know about ED visits immediately, and can follow up as appropriate
with the ED physician or the patient.
have direct, granular control of paged alerts, so they can decide
whether and when to receive alerts via pager.
the initial blizzard of e-mails with corrections created some initial
extra work for the admitting staff, immediate feedback about errors
helped the ED and admitting staff improve the initial assignment
process, resulting in far fewer errors and less rework.
process was a major win for everyone patients, physicians,
admitting staff, and nurses (better information about who really
is responsible for the patient). With the exception of the programming
time, the process had no cost; it simply leveraged existing infrastructure
to create a rapid, self-correcting, feedback loop. This process
has been running continuously for several years without problems.
feedback is much more effective in helping improve a process,
because the person who makes a mistake is immediately made aware
and learns how to avoid it in the future.
physicians in creative use of technology has powerful effects;
this solution was the brainstorm of a physician who had been frustrated
for years with this problem, knew of our work, and suggested the
Posted 4 April 2008