Correlation between EHR alerts and emergency provider medical decision making and practices.

428 Background: Since their approval in 2011, immune checkpoint inhibitors (ICIs) are now first or second line therapy for numerous cancers. The side effects, collectively termed immune related adverse events (irAEs), are also becoming increasingly prevalent. As the emergency department (ED) is often the initial point of care, non-oncologic providers need to be able to recognize a potential irAE. Best Practice Alert (BPA) embedded in the electronic medical record have been explored as tool to support ED provider recognition of irAEs. Methods: A BPA was created that triggered when a patient, having received ICI within the past 6 months, presented to the ED or urgent care (UC). The BPA instructed providers to assess for a possible irAE and, if suspected, were directed to a corticosteroids order set and offered the option to consult hematology/oncology. The BPA also linked to irAE guidelines for ICI toxicity management. ED/UC providers were educated on irAE recognition and BPA utility during a departmental meeting. After an initial waiting period, BPA-triggered encounters were reviewed. Each encounter was assessed to determine if a knowledgeable provider would have reasonably considered irAE based on the chief complaint, history, and key exam or lab findings. This was compared to the ED/UC provider's BPA response and documentations in their medical decision making (MDM). Patients diagnosed with GI-related irAEs were further reviewed to identify characteristics linked to improved recognition. Results: 273 unique ED/UC encounters (June 2023 - April 2024) were reviewed. A diagnosed irAE was associated with the chief complaint for 36 of those unique encounters (26 unique patients). In the MDM, irAE was considered in 15/36 ED/UC notes (41%). The sensitivity of selecting the response “Initiate treatment for irAE”, a proxy positive indicator for irAE diagnosis, was 28%. The sensitivity of the MDM for irAE was 42%. During a 2-week period in April 2025 after a repeat education session with ED providers, there were 12 encounters that were consistent with irAE; however an irAE was considered in only 8.3% of MDM. Of the 26 patients, 6 were ultimately diagnosed with GI-related irAE. 2 had been sent by their oncologist and were started on corticosteroids. In 3 cases, ED providers consulted their oncologist, leading to steroid initiation. Two patients presenting spontaneously experienced delayed recognition and treatment. Conclusions: The BPA was designed to improve recognition of ICI toxicity by ED/UC providers in order to reduce delays in corticosteroid initiation and oncology consultation. Review of the selected BPA response and providers’ MDM as proxy for their diagnostic consideration reveals that providers are not appropriately considering ICI toxicity in a majority of instances. Communication between patient’s oncologist and ED provider improve likelihood of patient receiving appropriate corticosteroid therapy.