Emergency Physicians' Electronic Health Record use and High-Risk Unscheduled Return Visits: A Case-Control Study

Area of Science:

• Emergency Medicine
• Health Informatics
• Patient Safety

Background:

• Emergency physicians dedicate significant time to electronic health records (EHRs) during shifts, yet encounter time is limited.
• Empirical data linking EHR usage duration to patient safety outcomes in emergency departments (EDs) is scarce.

Purpose of the Study:

• To investigate the association between emergency physicians' EHR use during index visits and the occurrence of high-risk unscheduled returns to the ED.
• High-risk unscheduled returns were defined as ED visits resulting in hospital admission within 72 hours of a prior ED discharge.

Main Methods:

• A retrospective case-control study was conducted involving adult patients across three EDs from March to August 2022.
• Cases were index ED visits preceding high-risk unscheduled returns, matched 1:1 with controls without such returns based on demographics, acuity, chief complaint, site, arrival time, and comorbidity index.
• Logistic regression was used to compare attending physicians' EHR time between cases and controls, adjusting for chief complaint and clustering by physician.

Main Results:

• Of 13,747 eligible ED visits, 300 (2.2%) were identified as cases and matched with 300 controls.
• Mean EHR time for index visits was 7.16 minutes (SD 5.70) for cases and 8.00 minutes (SD 6.23) for controls (p=0.08).
• Physician EHR time during index ED visits showed no significant association with high-risk unscheduled return visits (OR 0.98; 95% CI 0.95-1.00) after adjustment.

Conclusions:

• Attending physician EHR time during index emergency department visits was not associated with the likelihood of unscheduled returns.
• Further investigation into specific EHR use patterns and their impact on ED quality and safety, particularly for high-risk patient groups, is warranted.