B-262 Push, Chat, Loop Me In: Evaluating the Performance of a Tiered Closed-Loop Critical Result Notification System

Abstract

Background Timely communication of critical laboratory results is essential for patient safety and regulatory compliance. Although traditional phone-call based notification workflows are common, they can be labor intensive for laboratory staff and prone to delays related to paging, call back, and provider availability. Closed-loop notification systems can modernize these workflows through automated push alerts and secure messaging, reducing communication barriers while maintaining timely acknowledgement of critical results. At our institution, a closed-loop notification system using automated push alerts was implemented to replace traditional phone-call based reporting as the primary communication method. One year later, the escalation pathway was further enhanced by incorporating secure chat messaging as a secondary step for unacknowledged push alerts, with phone-call notification reserved only for results not acknowledged electronically. Here, we evaluate the performance of our closed-loop notification system to effectively communicate critical results while improving workflow efficiency and reliability. Methods All chemistry critical values occurring in inpatient and emergency department (ED) settings from November 2024-January 2026 at UC Irvine Medical Center were analyzed retrospectively. Three notification pathways were evaluated, each with an expected turnaround time (TAT) =30 min: (1) verbal phone communication, (2) automated push notification with follow-up phone call if no response within 15 minutes, and (3) tiered closed-loop system including automated push notification followed by secure chat message if no response after 15 minutes, and phone call if no response after 20 minutes. Notification TAT was defined as the interval from result verification to clinician acknowledgement. Critical value data were extracted monthly from Epic Beaker using a customized report. Median TAT, 95th percentile TAT, and electronic acknowledgement patterns were calculated using Microsoft Excel. Results Historically, all critical results at our institution were communicated exclusively via telephone. Prior to November 2024, the median TAT for chemistry results was consistently 2 minutes; however, the percentage of critical values communicated within 30 minutes ranged from 94 to 96%. Following implementation of a closed-loop system, approximately 80% of inpatient and ED chemistry critical results qualified for an automatic push alert. During the initial implementation period from November to December 2024, less than 50% of push notifications were acknowledged by clinicians, requiring phone calls for the remaining critical results, likely reflecting limited provider and lab staff familiarity with the new notification workflow. Over time, push notification acknowledgement rates improved, reaching a peak of 70%, with a reduction in median TAT from 6 minutes to 2 minutes. Overall, approximately 96% of critical chemistry results were acknowledged within 30 minutes. With the introduction of secure chat in December 2025, several improvements were noted, including an increase in the electronic acknowledgement rate to 81%. The median TAT was 3 min and 92% of chemistry critical values were acknowledged within 30 minutes, which is comparable performance to the previous closed-loop system. Conclusion A closed-loop notification system integrating automated push alerts with and without secure chat escalation maintained timely communication of critical results. Electronic escalation pathways may allow institutions to preserve communication performance while decreasing manual notification burden and improving process reliability.