Workflow and Clinical Utility of Multigene Preemptive Pharmacogenomic Testing in the Emergency Department: A Single-Center Cohort Study

Background: Preemptive, multigene pharmacogenomic (PGx) testing is on the rise in healthcare facilities. The emergency department (ED) has not historically been an area for high testing volume in many facilities; however, this could be an underutilized resource. Objectives: To describe the workflow and clinical utility of PGx testing in the ED. Methods: This was a single-center retrospective chart review of patients who received PGx testing in the ED (n = 100) with a 16-gene panel between January and November 2025. Medical records were reviewed for actionable gene variants and prescribed gene-drug pairs. Risk of adverse drug events (ADEs) was evaluated through the Vital, Important, Optional, Not indicated, Every medication has an indication (VIONE) score card. Baseline characteristics were also collected, and outcomes were described with descriptive statistics. Results: There were actionable genetic variants identified in 99% of patients tested, with the majority having multiple variants. Gene-drug pairs were found in 53% of patients: 38% one medication, 12% two medications, 3% three or more medications. A mean VIONE score of 5 revealed a moderate to high risk of ADE. Conclusion: PGx testing is feasible within ED workflow and has a high yield of potential clinical utility.