Value of Technology to Transfer Discharge Information

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Project Details -
Completed

The objective of this project was to measure effects of a discharge software application of computerized physician order entry (CPOE). Discharge communication between inpatient and outpatient physicians is error-prone. Adverse events result from poor discharge communication. The value of discharge software to improve clinically relevant outcomes is unknown. Discharge software was studied at a teaching hospital. Participants were internal medicine hospitalist physicians and patients who had high probability of readmission. The design was cluster-randomized, controlled, with discharging hospitalist as unit of randomization and with allocation concealment. The intervention was discharge software with CPOE versus usual care (handwritten) discharge. Follow-up was six months. Database abstraction and blinded interviews assessed patient readmissions, emergency department visits, and adverse events after discharge. Un-blinded interviews or questionnaires measured patient and physician perceptions of discharge. Hospitalists (n=70) discharged 631 patients to home. When comparing patients assigned to discharge software or usual care, there was no difference in hospital readmission (37.0% vs. 37.8%), emergency department visits (35.4% vs. 40.6%), or adverse events (7.3% vs. 7.3%). Discharge software patients and their outpatient physicians had better perceptions of discharge. Hospitalist users of discharge software reported more effort but no difference in satisfaction with usual care.