Real-time EHR secure messaging to coordinate emergency department disposition for 30-day revisit patients.

Abstract

To evaluate whether real-time electronic health record (EHR)-based secure messaging between emergency department (ED) clinicians and prior discharge teams influences ED disposition decisions for patients re-presenting within 30 days of hospital discharge. This 18-month pre-post study included 27 592 ED revisit encounters across 3 campuses within one academic healthcare system. Robotic process automation generated a real-time EHR secure message connecting the ED attending with the index hospitalization discharge team during the ED disposition window. The primary outcome was the proportion of encounters resulting in ED disposition changes. Secondary outcomes included length of stay and messaging engagement by service, hospital campus, and time of day. Systemwide, inpatient readmissions rates were unchanged (49.4% vs 48.6%, P = .149), and observation status increased (7.0% vs 8.0%, P < .001). At one campus where messaging was paired with proactive care coordination, inpatient admissions decreased (56.9% vs 54.1%, P = .029) and treat-and-release increased (36.8% vs 39.6%, P = .024). Overall, 61.8% of messages received a response, but engagement did not correlate with disposition changes systemwide. Disposition changes occurred only where messaging was integrated with care coordination workflows with the operational capacity to act, indicating that real-time communication alone is insufficient without supporting infrastructure. Real-time EHR messaging may be most effective when paired with structured care coordination models rather than deployed as a standalone alerting tool.