A Secure Chat–Based Workflow to Support Medication Access for Mobility-Limited Emergency Department Patients

Mobility-limited patients frequently encounter barriers to accessing prescribed medications. Inpatient meds-to-beds programs address this gap, but are rarely available to emergency department (ED) patients due to restrictions on hospital inpatient pharmacies dispensing outpatient prescriptions. However, EDs that have on-site outpatient pharmacies can provide similar services through real-time coordination. We describe the development and early evaluation of an Epic Secure Chat-based “ED-to-Rx” workflow to improve medication access for mobility-limited ED patients being discharged with new outpatient prescriptions.

This quality improvement project was launched in June 2025. A secure “ED-to-Rx” chat was created and linked retail pharmacy, patient transport services, and the ED clinical team. ED clinicians initiated the chat to communicate when a mobility-limited patient was being discharged with a new prescription. Patient transport services then escorted patients to the outpatient pharmacy prior to leaving the hospital premises once the prescription was ready for pick-up. A retrospective chart review was performed for all chat uses to assess workflow success and to identify potential roadblocks. A follow-up survey was used to capture clinician feedback and suggestions.

In the first 3 months, ED-to-Rx was activated for 9 patients (mean age 59.1 years), all of whom were unaccompanied at discharge. Four patients were older than 65 years, 3 presented for traumatic injuries, and 1 was undomiciled. The workflow was successfully completed for 8 patients. 1 failure occurred during the launch week due to miscommunication on a patient’s status as an inpatient vs. an ED patient. User feedback highlighted difficulty recalling the name of the ED-to-Rx chat during clinical shifts, prompting the implementation of synonyms to improve usability.

ED-to-Rx is a low-resource workflow using existing infrastructure to coordinate prescription pickup for mobility-limited patients being discharged from the ED. This model has the potential to improve medication access and adherence for this patient population, and is readily implementable in EDs with on-site outpatient pharmacies. Future evaluations should assess downstream outcomes like medication adherence, unplanned return visits, and patient satisfaction.