Targeted EHR-based communication of diagnostic uncertainty (TECU) in the emergency department: Protocol for an...

At least 37 % emergency department (ED) patients are discharged without a definitive diagnosis, resulting in diagnostic uncertainty. Transitions of care are high-risk periods for patient safety, especially for patients discharged with diagnostic uncertainty. Effective communication between clinicians and patients improves these care transitions. Previous research developed tools to support high quality discharge in the setting of diagnostic uncertainty, including: a communication checklist, a physician training program, and a patient-facing information sheet.

This study aims to enhance transitions for patients leaving the ED with diagnostic uncertainty through an electronic health record (EHR)-based strategy. The intervention, the Targeted EHR-based Communication about Uncertainty strategy, integrates use of an Uncertainty Communication Checklist and an Uncertainty Discharge Document into routine ED discharge workflows. The checklist aids clinicians in addressing topics of chief concern for ED patients discharged with diagnostic uncertainty. The patient-centered discharge document explains the concept of diagnostic uncertainty to patients. The pre-post trial seeks to test the intervention's effectiveness in reducing patient uncertainty and return ED visits compared to standard of care with 300 participants. It also aims to evaluate the intervention's adoption and implementation barriers and facilitators.

This trial builds on previous research to establish a communication strategy that equips patients with essential information for safe transitions amidst diagnostic uncertainty. The EHR-based strategy seeks to standardize communication and minimize bias and variation. Findings will be disseminated, to inform future trials and improve understanding of patient experiences with diagnostic uncertainty.

This trial was prospectively registered on 10/9/2024 with ClinicalTrials.gov (# NCT06638021).