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Evidence & Translation

→ Initial Clinical Impressions Are Absent in Around a Quarter of Adult Emergency Department Patient Consultations: Let’s Get Back to Basics
→ Statistical Analysis Plan

The Need

Have you ever left the Emergency Department unsure about your diagnosis or what the care plan was?

By standardising documentation of a structured initial clinical impression and management plan across Monash Health Emergency Departments, we aim to improve diagnostic accuracy, patient safety, and shared decision‑making. This initiative will enhance patient and family engagement, support clinicians, and reduce diagnostic errors and serious adverse patient safety events delivering safer, clearer and more efficient emergency care.

Our Approach

This project aims to standardise the documentation of a structured Initial Clinical Impression and Management Plan for all patients presenting to Monash Health Emergency Departments.

The intervention centres on a co-designed EMR AutoText, supported by education, leadership commitment and audit‑and‑feedback mechanisms.

PROJECT OBJECTIVES

Improve diagnostic safety by strengthening formulation and documentation of the initial clinical impression.
Enhance patient experience through shared understanding and collaboration with patients, families and carers.
Improve clinician experience by reducing uncertainty, cognitive burden and unnecessary testing

MULTIMODAL INTERVENTION COMPONENTS

Structured EMR AutoText (PROMPT-approved)

Supports diagnostic reasoning
Encourages articulation of diagnostic certainty or uncertainty
Identifies red flags and differential diagnoses
Prompts early management, investigations, disposition and senior review

EDUCATION AND CAPABILITY BUILDING

Face-to-face and hybrid education sessions
Mandatory Latte learning package
Diagnostic excellence principles embedded into clinical teaching

LEADERSHIP AND CULTURAL CHANGE

Emergency Service and executive endorsement
Establishment of a new standard of care for all patient cohorts

AUDIT, FEEDBACK AND CONTINUOUS IMPROVEMENTS

Monitoring of AutoText utilisation
Feedback linked to patient safety and diagnostic outcomes

CONSUMER AND PATIENT ENGAGEMENT

Co-design with consumer advisors
Revised Monash Health Experience Survey (MHES) questions focused on diagnostic communication

STUDY TIMELINE

Implementation: January 2024 – June 2024
Data collection and evaluation: 6–9 months during 2025

Impact

As a quality improvement and implementation initiative, this project will deliver immediate and sustainable benefits across Emergency Services.

By standardising documentation of structured clinical impressions and management plans, we expect to:

1. Reduce diagnostic errors and Serious Adverse Patient Safety Events (SAPSEs)
2. Improve clarity, continuity and safety of care
3. Reduce unnecessary test ordering through more targeted investigations
4. Support earlier treatment and safer, timelier discharge decisions
5. Strengthen collaboration with patients, families and carers
6. Improve clinician confidence, efficiency and experience

This initiative directly supports Monash Health’s Better, Smarter, Quicker priorities by improving decision‑making quality rather than volume, achieving the diagnostic “sweet spot” while minimising waste and harm.
In the long term, this work provides a scalable, reproducible model for diagnostic excellence that can be embedded across EDs, supporting both jurisdictional and national improvement in patient safety and diagnostic quality.

Funding

The project is supported by in-kind support of the participating investigators.

Coordinating Organisation

The School of Clinical Sciences. Faculty of Medicine, Nursing and Health Sciences. Monash University, Victoria, Australia.