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Alternatives for automated communication in research
Correspondence
Alternatives for Automated Communication in Research Andrew W. Murphy, MB, MD Molly Byrne, BA, MSc Pat Plunkett, MB, FRCSEd Hannah McGee, BA(Mod), PhD Gerard Bury, MB, MD Reply Debra L. Weiner, MD, PhD Atul J. Butte, MD, MS Patricia L. Hibberd, MD, PhD Gary R. Fleisher, MD Scleroderma Renal Crisis LTC Bruce D. Adams, MD, MC, USA Elevated Brain Natriuretic Peptide in Septic Patients Without Heart Failure Alan E. Jones, MD Jeffrey A. Kline, MD
Copyright © 2003 by the American College of Emergency Physicians. 0196-0644/2003/$30.00 + 0
7 1 2
Alternatives for Automated Communication in Research To the Editor:
We were very interested to read the article by Weiner et al1 in the February 2003 issue of Annals (article #52). They reported on the use of a realtime automated notification system at the time of emergency department (ED) registration to identify potential patients for a clinical trial on the basis of routinely collected information. They found that the automated notification system improved their rate of investigator notification (84% versus 56% of potentially eligible patients). They concluded that the automated notification system was a potentially valuable tool in the recruitment of patients for clinical trials. Our recent experience using a novel e-mail system for the identification of frequent attenders to an ED strongly supports this conclusion.2 In our study, an alerting e-mail message was automatically sent to the off-site researcher when a patient from the selected frequent attender sample registered at the ED. We wish to highlight 3 attributes of an automated notification system in addition to those identified so clearly by Weiner et al.1
First, the notification system was used by an off-site researcher. For relatively rare presentations to EDs, an on-site researcher is an expensive resource. Off-site notification also facilitates block sampling of patients, especially those who attend out of hours. This is very important for ensuring that a study sample is representative of the total population attending EDs. Second, unlike the system described by Weiner et al,1 patient confidentiality was guaranteed by using only unique patient identifying numbers. This system worked well and ensured absolute patient confidentiality. Only when the researcher made contact with the ED staff was the individual identified. Finally, in our study, it was necessary to consider 253 patients before a study sample of 200 was achieved. Patients were deemed unsuitable for reasons such as “too ill to participate,” “unable to provide informed consent,” or “too aggressive or threatening.” It was possible for many of these ineligible patients to be identified and noted by the off-site researcher in telephone conversations with ED staff, precluding a “futile” visit to the ED. This approach also turned out to have unexpected additional benefits with regard to the personal safety of the researcher.
ANNALS OF EMERGENCY MEDICINE
42:5
NOVEMBER 2003
CORRESPONDENCE
We would also suggest that an important potential clinical use of automated notification systems may be in the coordination of care for patients who have multiple providers such as family physicians, EDs, and specialist clinics. Such coordination is vital to ensure that optimal patient care is provided.3 Andrew W. Murphy, MB, MD Molly Byrne, BA, MSc Department of General Practice National University of Ireland, Galway, Ireland Pat Plunkett, MB, FRCSEd Department of Emergency Medicine St. James’s Hospital Dublin, Ireland Hannah McGee, BA(Mod), PhD Health Services Research Centre Department of Psychology Royal College of Surgeons in Ireland Dublin, Ireland Gerard Bury, MB, MD Department of General Practice University College Dublin Dublin, Ireland doi:10.1067/mem.2003.374 1. Weiner DL, Butte AJ, Hibberd PL, et al. Computerized recruiting for clinical trials in real time. Ann Emerg Med. 2003;41:242-246. 2. Byrne M, Murphy AW, Plunkett PK, et al. Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med. 2003:41:309-318. 3. Starfield B. Primary Care: Balancing Health Needs, Services and Technology. Oxford, United Kingdom: Oxford University Press; 1998.
NOVEMBER 2003
42:5
ANNALS OF EMERGENCY MEDICINE
7 1 3
Alternatives for Automated Communication in Research Andrew W. Murphy, MB, MD Molly Byrne, BA, MSc Pat Plunkett, MB, FRCSEd Hannah McGee, BA(Mod), PhD Gerard Bury, MB, MD Reply Debra L. Weiner, MD, PhD Atul J. Butte, MD, MS Patricia L. Hibberd, MD, PhD Gary R. Fleisher, MD Scleroderma Renal Crisis LTC Bruce D. Adams, MD, MC, USA Elevated Brain Natriuretic Peptide in Septic Patients Without Heart Failure Alan E. Jones, MD Jeffrey A. Kline, MD
Copyright © 2003 by the American College of Emergency Physicians. 0196-0644/2003/$30.00 + 0
7 1 2
Alternatives for Automated Communication in Research To the Editor:
We were very interested to read the article by Weiner et al1 in the February 2003 issue of Annals (article #52). They reported on the use of a realtime automated notification system at the time of emergency department (ED) registration to identify potential patients for a clinical trial on the basis of routinely collected information. They found that the automated notification system improved their rate of investigator notification (84% versus 56% of potentially eligible patients). They concluded that the automated notification system was a potentially valuable tool in the recruitment of patients for clinical trials. Our recent experience using a novel e-mail system for the identification of frequent attenders to an ED strongly supports this conclusion.2 In our study, an alerting e-mail message was automatically sent to the off-site researcher when a patient from the selected frequent attender sample registered at the ED. We wish to highlight 3 attributes of an automated notification system in addition to those identified so clearly by Weiner et al.1
First, the notification system was used by an off-site researcher. For relatively rare presentations to EDs, an on-site researcher is an expensive resource. Off-site notification also facilitates block sampling of patients, especially those who attend out of hours. This is very important for ensuring that a study sample is representative of the total population attending EDs. Second, unlike the system described by Weiner et al,1 patient confidentiality was guaranteed by using only unique patient identifying numbers. This system worked well and ensured absolute patient confidentiality. Only when the researcher made contact with the ED staff was the individual identified. Finally, in our study, it was necessary to consider 253 patients before a study sample of 200 was achieved. Patients were deemed unsuitable for reasons such as “too ill to participate,” “unable to provide informed consent,” or “too aggressive or threatening.” It was possible for many of these ineligible patients to be identified and noted by the off-site researcher in telephone conversations with ED staff, precluding a “futile” visit to the ED. This approach also turned out to have unexpected additional benefits with regard to the personal safety of the researcher.
ANNALS OF EMERGENCY MEDICINE
42:5
NOVEMBER 2003
CORRESPONDENCE
We would also suggest that an important potential clinical use of automated notification systems may be in the coordination of care for patients who have multiple providers such as family physicians, EDs, and specialist clinics. Such coordination is vital to ensure that optimal patient care is provided.3 Andrew W. Murphy, MB, MD Molly Byrne, BA, MSc Department of General Practice National University of Ireland, Galway, Ireland Pat Plunkett, MB, FRCSEd Department of Emergency Medicine St. James’s Hospital Dublin, Ireland Hannah McGee, BA(Mod), PhD Health Services Research Centre Department of Psychology Royal College of Surgeons in Ireland Dublin, Ireland Gerard Bury, MB, MD Department of General Practice University College Dublin Dublin, Ireland doi:10.1067/mem.2003.374 1. Weiner DL, Butte AJ, Hibberd PL, et al. Computerized recruiting for clinical trials in real time. Ann Emerg Med. 2003;41:242-246. 2. Byrne M, Murphy AW, Plunkett PK, et al. Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med. 2003:41:309-318. 3. Starfield B. Primary Care: Balancing Health Needs, Services and Technology. Oxford, United Kingdom: Oxford University Press; 1998.
NOVEMBER 2003
42:5
ANNALS OF EMERGENCY MEDICINE
7 1 3