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Appl Clin Inform 2026; 17(01): 073-081
DOI: 10.1055/a-2804-5877
Research Article

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

Authors

  • Christina L. Cifra 

    1   Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
    2   Division of Pediatric Critical Care Medicine, University of Iowa Health Care Stead Family Department of Pediatrics, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, United States

  • Priynt Patel

    3   Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, United States

  • Cody R. Tigges

    2   Division of Pediatric Critical Care Medicine, University of Iowa Health Care Stead Family Department of Pediatrics, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, United States

  • Sarah L. Miller

    4   Department of Emergency Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, United States

  • Olivia Lin

    5   Harvard College, Harvard University, Boston, Massachusetts, United States

  • Irene Pantekidis

    6   Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States

  • Alison Bronson

    7   Health Care Information Systems, University of Iowa Health Care, Iowa City, Iowa, United States

  • Raquel E. Gomez

    8   Department of Emergency Medicine, Prisma Health, University of South Carolina School of Medicine, Columbia, South Carolina, United States

  • Priyadarshini R. Pennathur

    9   Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at El Paso, El Paso, Texas, United States

  • Erik Westlund

    10   Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States

  • Dean F. Sittig

    11   Informatics Review LLC, Lake Oswego, Oregon, United States

  • Hardeep Singh

    12   Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, United States

Funding Information 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.
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Abstract

Background

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.

Objectives

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.

Methods

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).

Results

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 (p < 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 (p < 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, p < 0.001).

Conclusion

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.

Keywords

pediatrics - critical care - emergency department - audit and feedback - diagnostic error

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research involving Human Subjects. The University of Iowa Institutional Review Board (IRB) reviewed and approved this study (IRB #201911358, December 3, 2019, and IRB approval no.: 202105599, July 22, 2021).


Supplementary Material



Publication History

Received: 14 September 2025

Accepted: 03 February 2026

Article published online:
24 February 2026

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