Impact of an Electronic Health Record–Integrated Multidisciplinary Foot Wound Pathway in the Emergency Department

Patients presenting to the emergency department (ED) with complex foot wounds often require coordinated multidisciplinary evaluation. We assessed whether implementation of a foot-wound pathway, and subsequent electronic health record (EHR) integration, was associated with improved throughput and length of stay (LOS).

We conducted a retrospective cohort study of adult ED encounters at a single academic center (June 2023-September 2025), identified using ICD-10 diagnosis codes for foot wounds (N=1,287). Encounters were categorized by implementation phase: No Protocol (Jun 2023-May 2024), Paper Pathway (Jun-Dec 2024), and EHR-Integrated Pathway (Jan-Sep 2025). Primary outcomes were ED LOS (minutes), hospital LOS (days; admitted patients), and admission rate. ED LOS was decomposed into arrival-to-first-provider contact (pre-contact) and first-provider-contact-to-disposition (post-contact). We fit generalized additive location-scale models to log-transformed outcomes with tensor smooths for arrival hour and calendar month.

Of 1,287 encounters, 702 (54.5%) resulted in admission; the EHR-Integrated phase included 383 encounters (239 admitted). Compared with No Protocol, both pathway phases were associated with a shorter pre-contact time (p<0.001). After adjustment, post-contact time did not differ by phase, and total ED LOS and admission rates were similar across phases. Among admitted patients, the EHR-Integrated phase was associated with shorter hospital LOS than No Protocol (adjusted ≈17% reduction), whereas the Paper Pathway was not; unadjusted estimates suggested a larger reduction (≈34%). The use of any protocol tended to reduce wait times pre-contact, post-contact, and for hospital LOS. The largest differences occurred in pre first contact, during the afternoon hours and during the summer months. Post first contact reduction in wait times was far smaller in magnitude, especially after adjusting for patient characteristics. Hospital LOS reduction occurred only in the EHR Integrated pathway and only for those patients admitted during the afternoon hours of the summer months.

EHR integration of a multidisciplinary foot-wound pathway was associated with reduced inpatient LOS without detectable changes in ED LOS or admission rate, supporting digital pathway deployment to improve downstream efficiency.