Secure chat and critical/urgent imaging-result communication in a multisite emergency department system

Closed-loop communication of critical and urgent imaging findings is essential for patient safety, but traditional verbal-only workflows can introduce friction and limit communication throughput. Epic Secure Chat, an EHR-integrated messaging platform, may reduce friction while preserving closed-loop communication requirements. This study evaluated communication volume, radiologist interpretation throughput, clinician experience, and reported safety events following implementation of a Secure Chat-first protocol.

A prospective pre-post cohort study of operational outcomes was conducted across 26 emergency departments within a large academic health system, with a concurrent post-implementation survey. Following a 205-day overnight Secure Chat pilot, operational data were compared with a 161-day pre-implementation period using paired t-tests. Communication and examination volumes were normalized by time period. Linear regression was used to assess the association between Secure Chat volume and interpretation throughput change.

Survey responses were obtained from 48 emergency physicians (20.2%) and 19 radiologists (48.7%). Most emergency physicians (77%) and radiologists (95%) supported Secure Chat as a supplemental modality and reported improved communication ease. Documented critical and urgent result communications increased by 26.5% (mean increase 21.4 communications per radiologist; 95% CI 2.9-39.8; p=0.026). Radiologist interpretation throughput did not significantly change (+0.58%; p=0.833), with no association between Secure Chat volume and throughput change (R²=0.023; p=0.508). No Secure Chat-associated safety events were identified across 1087 reviewed communications.

Implementation of a Secure Chat-first protocol with a verbal failsafe was associated with increased communication volume without a reduction in radiologist throughput or identified safety events.

American College of Emergency Physicians National Meeting, Salt Lake City, Utah 2025.