EMR Clinical Impression dot‑phrase nudge to improve documentation and diagnostic certainty in Australian Emergency Departments
The iIMPROVE Diagnostic Excellence project is a local initiative across four Monash Health Emergency Departments. Following a retrospective review of 2023–2024 data that identified diagnostic error as a contributor to up to two-thirds of adverse patient events, a Diagnostic Excellence Working Group was established. A dedicated subgroup has since evolved into the iIMPROVE Diagnostic Excellence program.
Structured Clinical Impression Project
A key component of the initative has been the implementation of a co-designed electronic medical record (EMR) Dot Phrase. Developed with input from both clinicans and consumers, the EMR aims to prompt consideration of differential diagnosis, red flags and patient vulnerabilities during inital assessment, supporting more deliberate clinical reasoning and decision-making.
Monash Health embedded the Structured Clinical Impression Model (SCIM) into everyday clinical workflows through an EMR auto-text (“dot phrase”) tool supported by policy redesign, clinician engagement via mascot design competition (Figure 1), consumer co-design, education, and cultural transformation.
Sustainability and Long Term-Value
1. Embedded into core EMR workflows and policy (Prompt Procedure)
2. Reinforced through
- Audit and feedback loops
- Continuous data monitoring
- Training and short-form instructional videos