Effect of an Outcome Feedback Reporting System on Emergency Department Physicians' Chart Reaccess

Abstract

Background Learning about critically ill children's outcomes after transfer to the pediatric intensive care unit (PICU) can help emergency department (ED) physicians improve future performance. However, there are no standard processes in place to systematically provide this information; thus, most ED physicians obtain inconsistent feedback. Objectives We aimed to determine the effect of delivering patient outcome feedback through the electronic health record (EHR) on the frequency of ED physicians' re-access of patients' EHRs after PICU transfer. Methods We performed a retrospective cohort study at an academic tertiary referral hospital before and after implementing an EHR-based system delivering individual patient outcome feedback to ED physicians who admitted children from the ED to the same institution's PICU (2019-2021). Results A total of 180 patients transferred to the PICU by 30 unique ED physicians were included (100 pre- and 80 postintervention). After implementing the feedback system, the proportion of patients for whom ED physicians re-accessed the EHR increased from 26% preintervention to 80% postintervention (p < 0.001). Propensity score-adjusted multivariable modeling accounting for patient, clinician, encounter, and diagnostic covariates showed a significant association between receipt of patient outcome feedback reports and ED physicians' EHR re-access, with the rate of EHR re-access 2.58 times higher in the postintervention cohort (p < 0.001). The estimated marginal means, which provide an adjusted average outcome for each cohort, showed a significantly higher number of EHR re-access episodes per patient postintervention (0.44 [95% CI: 0.3, 0.66] pre- vs. 1.14 [95% CI: 0.86, 1.51] postintervention, p < 0.001). Conclusion Receipt of consistent patient outcome feedback increased ED physicians' re-access of patients' EHRs after PICU transfer, potentially allowing them to obtain information that can be used to improve future clinical performance. Further study is needed to determine the effectiveness of feedback systems in improving clinician practice and outcomes of critically ill children.