text: **JAMA Network Open | Emergency Medicine**
  
  superior performance. However, while the manual clinical evaluation demonstrated the majority of 
  
  the LLM-generated notes were of promising comparative quality (scores of 4-5), they were, on 
  
  average, inferior to the clinician-written notes. 
  
  Our novel clinical evaluation’s findings suggest the majority of identified quality limitations and 
  
  incorrectness would have minimal impact on patient safety, even when extrapolated to the worst- 
  
  case scenario of the LLM-generated summary content not being reviewed and edited by a clinician 
  
  before completion. This was designed to address contemporary LLM concerns of user trust, reliance 
  and expertise.49 As such, none of the incorrect output text elements reached life-threatening risk. 
  However, incompleteness and faulty logic identified in the automated summaries were not always 
  
  negligible, with just under 1 in 10 of these performance gaps determined to have the potential to 
  
  create significant patient safety risk compared with the physician-written summaries. These critical 
  
  implementation safety findings will inform (1) directionality of further model refinement; (2) further 
  
  clinical evaluation of postrefinement model output; and (3) irrespective of downstream model 
  
  performance, an EHR-implementation plan constrained to a user-interface design that will allow EM 
  
  clinicians to review and edit the LLM-generated handoff note as a draft before finalizing (see 