Development and feasibility testing of an Electronic Medical Record intervention to improve emergency department discharge communication for patients with uncertainty: a pilot study

Abstract Background: A significant proportion of patients leave the emergency department (ED) without a definitive diagnosis, leading to challenges in the post-discharge period due to diagnostic uncertainty. Building on previous work aimed at improving discharge communication, we developed the Targeted Electronic Health Record (EHR)-based Communication about Uncertainty (TECU) Best Practice Advisory (OPA) to address this issue by alerting clinicians in real-time when a patient receives discharge orders from the ED without a definitive diagnosis. Methods: This pilot study aimed to evaluate the feasibility and usability of the TECU OPA in an ED setting. Conducted at Thomas Jefferson University Hospital (TJUH), the study enrolled clinicians who participated in three phases of pilot testing, from May to August 2024, to refine the OPA's design and functionality. The TECU OPA is an alert triggered when a symptom-based diagnosis is entered in the EHR, prompting clinicians to initiate a structured discharge conversation about diagnostic uncertainty. After engagement, clinicians evaluated the acceptability, feasibility, and usability of the OPA, while patients provided feedback on their understanding and satisfaction with the discharge process. Discussion: Clinicians were satisfied with the OPA's usability and relevance in guiding discharge conversations. Patients appreciated the clarity and simplicity of the discharge communication. The iterative process of refining the OPA based on feedback ensured its accuracy in identifying eligible patients and facilitated its integration into clinical practice. This study provides promising initial data for implementing an OPA in the EHR to improve discharge transitions for patients with diagnostic uncertainty. Further testing is needed to explore the broader applicability and long-term impact of this approach. Trial Registration: N/A Trial Funding: Agency for Healthcare Research and Quality (grant number R18HS029791)