Targeted EHR-based Communication of Diagnostic Uncertainty (TECU) in the ED: An Effectiveness Implementation Trial
Thomas Jefferson University
Summary
The goal of the clinical trial is to evaluate the preliminary effectiveness and the implementation feasibility of the Targeted EHR-based Communication about Uncertainty (TECU) strategy in improving the quality of care transitions from the emergency department (ED) to home. The overall specific aims related to the trial are to test the preliminary effectiveness of TECU compared to standard of care in reducing patient uncertainty and return ED visits and evaluate the adoption of TECU, exploring patient and clinician barriers and facilitators to TECU implementation.
Description
At least 37% of patients treated in the emergency department (ED) are discharged without a definitive diagnosis, thus leaving the encounter with diagnostic uncertainty. Transitions of care are high-risk periods for patient safety, especially when patients are discharged with diagnostic uncertainty, and thus are still within the diagnostic process. Effective communication between clinicians and patients is essential to improve the quality of these care transitions. In prior AHRQ-funded research, the investigators developed several tools to support high quality discharge in the setting of diagno…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Patient Inclusion Criteria: * age 18 years or older * English language speaking * assigned a symptom-based diagnosis in the EHR clinical impression * planned for discharge from the ED during the enrollment visit * able to complete follow up assessments in 2 and 30 days * TECU best practice advisory (BPA) electronic health record alert activates during their discharge process Patient Exclusion Criteria: * under the age of 18 years * non-English speaking * clinically unstable, psychologically impaired or intoxicated, or otherwise unable to provide informed consent as judged by research staff…
Interventions
- BehavioralTargeted EHR-based Communication of Diagnostic Uncertainty (TECU)
The Targeted EHR-based Communication about Uncertainty (TECU) strategy will be activated in the electronic health record (Epic) every time an ED clinician enters an uncertain diagnosis for a patient being discharged, and will notify the clinician to counsel the patient about uncertainty while additionally triggering automated 1) insertion and printing of the patient handout and 2) provision of a hyperlink for the clinician-facing checklist to guide the discharge conversation.
Location
- Thomas Jefferson UniversityPhiladelphia, Pennsylvania