The effectiveness of emergency medicine follow-up in attaining closed loop communication and downstream follow-up

Utilization of different Electronic Health Records (EHR) impedes communication between Emergency Medicine (EM) and Primary Care Provider (PCP) necessitating study on EM's effectiveness in enabling continuity of care following patient discharge. This study's objective was to evaluate the effectiveness of an EM-based follow-up program using secure email for closed-loop communication and follow-up of incidental findings (IF) after EM discharge.

Retrospective study of IFs from two Emergency Departments (ED) and one urgent care between 9/1/20-8/30/21. Preceding day IFs were identified by an EM Quality Assurance (QA) team who then notified the patient's PCP via email. Automated rules-based natural language processing (NLP) of emails linking data to EHRs. Chart reviewing of outcomes included whether closed loop communication was established (via a PCP reply acknowledging IF receipt) and whether follow-up care occurred within 12 months. Multivariate logistic regression models examined factors associated with each outcome.

Of 1781 IF notifications, 62 % were female, 77 % white, and 91 % English speaking. PCP replied to 39.1 %; 64.9 % were ultimately followed-up. Patient and IF characteristics were not associated with PCP reply. PCP tenure and EM/PCP EHR system concordance were associated with higher adjusted Odds Ratio (aOR) of PCP reply (aOR 1.05 [1.04-1.07] vs 2.6 [2.0-3.3]). Laboratory IFs were followed-up more than imaging IFs (aOR 1.94 [1.46-2.6]). EM/PCP Use of same EHR was associated with higher odds of some form of follow-up (aOR: 2.1 [1.7-2.7]).

While email notifications and using the same EHR improve continuity of care, they are insufficient on their own. More comprehensive solutions are needed to enable EM-PCP communication and patient follow-up.