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

Emergency physicians spend hours on the electronic health record (EHR) per shift but only minutes per encounter. Empiric evidence regarding the relationship between EHR time and safety outcomes is scant.

To evaluate whether emergency physicians' EHR use was associated with of high-risk unscheduled returns, defined as an emergency department (ED) visit resulting in hospital admission within 72 h of a preceding ED discharge (index visit).

Retrospective case-control study of adult patients at 3 EDs in a single health system from March-August 2022 with any of the 10 most common chief complaints. Index ED visits (cases) preceding high-risk unscheduled returns were matched 1:1 to controls without subsequent high-risk unscheduled returns matching on age, sex, acuity score, chief complaint, site, night arrival, and Charlson comorbidity index. Attending physicians' EHR use time was compared between cases and controls using logistic regression adjusted for chief complaint and clustered by physician.

Of 13,747 ED visits meeting inclusion criteria, 300 (2.2%) met our case definition; these were matched to 300 controls with similar baseline characteristics. Physicians spent a mean (SD) of 7.16 (5.70) EHR minutes on cases, compared to 8.00 (6.23) min on controls (p = 0.08). Index visit EHR time (in minutes) was not associated with high-risk unscheduled return visits (OR 0.98; 95% CI 0.95-1.00) in adjusted analyzes.

Attending physicians' EHR time on index ED visits was not associated with odds of unscheduled return. Future research should further examine the association between EHR use patterns and ED quality and safety, including in high-risk groups.