text: **Abstract**
  
  **IMPORTANCE**An emergency medicine (EM) handoff note generated by a large language model 
  
  of EM-to-inpatient (IP) handoffs. 
  
  **OBJECTIVE**To develop LLM-generated EM-to-IP handoff notes and evaluate their accuracy and 
  
  safety compared with physician-written notes. 
  
  **DESIGN, SETTING, AND PARTICIPANTS**This cohort study used EM patient medical records with 
  
  acute hospital admissions that occurred in 2023 at NewYork-Presbyterian/Weill Cornell Medical 
  
  EM-to-IP handoff notes. Using both conventional automated methods (ie, recall-oriented 
  
  score [BERTScore], and source chunking approach for large-scale inconsistency evaluation [SCALE]) 
  
  and a novel patient safety-focused framework, LLM-generated handoff notes vs physician-written 
  
  notes were compared. Data were analyzed from October 2023 to March 2024. 
  
  **EXPOSURE**LLM-generated EM handoff notes. 
  
  **MAIN OUTCOMES AND MEASURES**LLM-generated handoff notes were evaluated for (1) lexical 
  
  similarity with respect to physician-written notes using ROUGE and BERTScore; (2) fidelity with 
  
  respect to source notes using SCALE; and (3) readability, completeness, curation, correctness, 
  
  usefulness, and implications for patient safety using a novel framework. 