Result Push Notifications Improve Time to Emergency Department Disposition: A Pragmatic Observational Study

Emergency department (ED) crowding has multiple causative factors, including delayed patient throughput. Patient care efficiency may be improved by addressing delays in decisionmaking following diagnostic testing results. We examined the influence of sending subscribed result push notifications to ED clinicians' smartphones on reducing the time to disposition decision. All ED patient visits between October 2022 and October 2023 with a laboratory or imaging result during the ED visit and a disposition within 6 hours of the last result were included. We identified whether the last resulted study before the ED disposition decision had a subscribed push notification by the clinician who dispositioned the patient. The primary outcome was the time between the last study result and the first disposition decision. Generalized estimating equation analysis was used to control for variables including patient demographics, clinical factors, and discharging clinician. The final study population included 237,872 encounters. The median patient age was 50 years, and 55.6% of patients were women. During the study period, 27.1% of clinicians used push notifications at least once. Of unique orders, 1.5% had a subscribed result push notification, including 0.9% of laboratory orders and 4.7% of imaging orders. The time between last result to disposition decision was 18 minutes (95% confidence interval [CI] 15 to 21) faster when a push notification was requested. Elective push notification of test results was associated with reduced time between the last laboratory or imaging result and ED disposition decision. Further study is needed to determine its effect on overall ED throughput.