Effect of an Outcome Feedback Reporting System on Emergency Department Physicians' Chart Reaccess

Christina L Cifra; Priynt Patel; Cody R Tigges; Sarah L Miller; Olivia Lin; Irene Pantekidis; Alison Bronson; Raquel E Gomez; Priyadarshini R Pennathur; Erik Westlund; Dean F Sittig; Hardeep Singh

doi:10.1055/a-2804-5877

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Effect of an Outcome Feedback Reporting System on Emergency Department Physicians' Chart Reaccess

Christina L Cifra, Priynt Patel, Cody R Tigges, Sarah L Miller, Olivia Lin, Irene Pantekidis, Alison Bronson, Raquel E Gomez, Priyadarshini R Pennathur, Erik Westlund, …

Applied clinical informatics, Vol.17(1), pp.73-81

01/2026

DOI: 10.1055/a-2804-5877

PMCID: PMC12932033

PMID: 41734900

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Abstract

Learning about critically ill children's outcomes after transfer to the pediatric intensive care unit (PICU) can help emergency department (ED) physicians improve future performance. However, there are no standard processes in place to systematically provide this information; thus, most ED physicians obtain inconsistent feedback.We aimed to determine the effect of delivering patient outcome feedback through the electronic health record (EHR) on the frequency of ED physicians' re-access of patients' EHRs after PICU transfer.We performed a retrospective cohort study at an academic tertiary referral hospital before and after implementing an EHR-based system delivering individual patient outcome feedback to ED physicians who admitted children from the ED to the same institution's PICU (2019-2021).A total of 180 patients transferred to the PICU by 30 unique ED physicians were included (100 pre- and 80 postintervention). After implementing the feedback system, the proportion of patients for whom ED physicians re-accessed the EHR increased from 26% preintervention to 80% postintervention ( < 0.001). Propensity score-adjusted multivariable modeling accounting for patient, clinician, encounter, and diagnostic covariates showed a significant association between receipt of patient outcome feedback reports and ED physicians' EHR re-access, with the rate of EHR re-access 2.58 times higher in the postintervention cohort ( < 0.001). The estimated marginal means, which provide an adjusted average outcome for each cohort, showed a significantly higher number of EHR re-access episodes per patient postintervention (0.44 [95% CI: 0.3, 0.66] pre- vs. 1.14 [95% CI: 0.86, 1.51] postintervention, < 0.001).Receipt of consistent patient outcome feedback increased ED physicians' re-access of patients' EHRs after PICU transfer, potentially allowing them to obtain information that can be used to improve future clinical performance. Further study is needed to determine the effectiveness of feedback systems in improving clinician practice and outcomes of critically ill children.

Electronic Health Records

Child

Emergency Service, Hospital

Feedback

Female

Humans

Male

Physicians

Retrospective Studies

Details

Title: Subtitle: Effect of an Outcome Feedback Reporting System on Emergency Department Physicians' Chart Reaccess
Creators: Christina L Cifra - Boston Children's Hospital
Priynt Patel - Children's Hospital of Los Angeles
Cody R Tigges - University of Iowa
Sarah L Miller - University of Iowa
Olivia Lin - Harvard University
Irene Pantekidis - Boston Children's Hospital
Alison Bronson - University of Iowa
Raquel E Gomez - University of South Carolina
Priyadarshini R Pennathur - The University of Texas at El Paso
Erik Westlund - Johns Hopkins University
Dean F Sittig - Information Technology Association of America
Hardeep Singh - Michael E. DeBakey VA Medical Center
Resource Type: Journal article
Publication Details: Applied clinical informatics, Vol.17(1), pp.73-81
DOI: 10.1055/a-2804-5877
PMID: 41734900
PMCID: PMC12932033
NLM abbreviation: Appl Clin Inform
ISSN: 1869-0327
eISSN: 1869-0327
Publisher: Thieme
Grant note: National Center for Advancing Translational Sciences of the National Institutes of Health: UM1TR004403 University of Iowa's Institute for Clinical and Translational ScienceAgency for Healthcare Research and Quality (AHRQ) through a K08 grant: HS026965 University of Iowa Carver College of Medicine Department of PediatricsHouston Veterans Administration (VA) Health Systems Research (HSR) Center for Innovations in Quality, Effectiveness and Safety: CIN13-413 Agency for Healthcare Research and Quality: R01HS028595, R18HS029347
This work's use of the REDCap platform was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (grant no.: UM1TR004403) through the University of Iowa's Institute for Clinical and Translational Science. C.L.C. was supported by the Agency for Healthcare Research and Quality (AHRQ) through a K08 grant (grant no.: HS026965) and an internal start-up grant from the University of Iowa Carver College of Medicine Department of Pediatrics. H.S. is funded in part by the Houston Veterans Administration (VA) Health Systems Research (HSR) Center for Innovations in Quality, Effectiveness and Safety (grant no.: CIN13-413) and the Agency for Healthcare Research and Quality (grant nos.: R01HS028595 and R18HS029347). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ, the Department of Veterans Affairs, or the U.S. government.
Language: English
Date published: 01/2026
Academic Unit: Critical Care; Stead Family Department of Pediatrics; Emergency Medicine; Nursing
Record Identifier: 9985139302802771

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