Automated Versus Conventional Hospital Discharge Summaries and Prescriptions

Automated Versus Conventional Hospital Discharge Summaries and Prescriptions: A Randomized Controlled Trial

The purpose of this study is to determine whether a semi-automated electronic patient discharge summary program leads to increased community physician and housestaff satisfaction and patient outcomes as compared to conventional discharge reports.

Study Overview

• Status: Completed
• Conditions: Continuity of Patient Care; Patient Discharge; Medical Records Systems, Computerized; Hospital Information Systems
• Intervention / Treatment: Other: Electronic discharge summary system

Detailed Description

For patients hospitalized with an acute illness, the days following discharge constitute a critical period. Patients must adjust to changes in their medications, follow up with family doctors and other specialists and know what symptoms should prompt a return to hospital. The community physicians who follow them rely on information from their hospitalization to facilitate this transition, and provide continuity of care.

Communication between hospital and community physicians is essential to this process, and has traditionally been accomplished by a dictated discharge summary. Previous studies have shown that while dictated discharge summaries can be inaccurate, incomplete, or untimely, computer generated summaries are produced more quickly and accurately. Moreover, database-generated discharge summaries are preferred by physicians in the community.

We have designed a web-based computer program with quality assurance features that automatically generates timely discharge summaries. We aim to study this program over a 2 month period on our general medicine unit by means of a randomized controlled trial. Our hypothesis is that community physicians will prefer the computer generated summaries, over the standard dictated summaries. If effective, our system could be implemented more widely, and would stand to improve communication with community physicians, continuity of care, and patient safety.

• Study Type: Interventional
• Enrollment (Actual): 209
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5B 1W8
      • St. Michael's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Hospitalization on General Internal Medicine ward at St. Michael's Hospital

Exclusion Criteria:

• Transfer to another service
• Death during admission
• Remains in hospital past dates specified in study protocol

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: eDischarge; The eDischarge arm will consist of two teams on the General Internal Medicine ward at St. Michael's Hospital who have been randomly assigned to use the electronic discharge summary program.	Other: Electronic discharge summary system; The customized electronic discharge summary program will be used to generate patient discharge summaries.
No Intervention: Traditional; The traditional arm will consist of two teams on the General Internal Medicine ward at St. Michael's Hospital who have been randomly assigned to use "traditional," dictated discharge summaries.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Primary care physician satisfaction from satisfaction score assessment form with 100-mm visual analogue scale	Satisfaction score assessment form to be sent one week after patient's discharge from hospital. If form is not returned in 14 days, a reminder and second form will be sent.

Secondary Outcome Measures

Outcome Measure	Time Frame
St. Michael's Hospital housestaff satisfaction from satisfaction score assessment form with 100-mm visual analogue scale	Housestaff will fill out form upon completion of the rotation during which the study has been performed
Completion of specialist outpatient workups at St. Michael's Hospital recommended during course of hospitalization	Within the first 30 days of patient's discharge from hospital
Patient visits to Emergency Room at St. Michael's Hospital	Within the first 30 days after patient's discharge from hospital
Patient/proxy care transition assessment through the use of the CTM-3.	Phone call made to patient or proxy one week after discharge. If patient/proxy is not reached, follow up calls will be made daily until patient/proxy is reached.
Prescribing errors as assessed by comparing discharge summary to inpatient record	Upon discharge
Patient readmissions to St. Michael's Hospital	Within 30 days of discharge

Collaborators and Investigators

• Sponsor: Unity Health Toronto
• Investigators: Principal Investigator: David M Maslove, MD, Unity Health Toronto; Principal Investigator: Chaim M Bell, MD, PhD, FRCPC, St. Michael's Hospital; University of Toronto

Publications and helpful links

General Publications

• van Walraven C, Laupacis A, Seth R, Wells G. Dictated versus database-generated discharge summaries: a randomized clinical trial. CMAJ. 1999 Feb 9;160(3):319-26.
• van Walraven C, Seth R, Austin PC, Laupacis A. Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med. 2002 Mar;17(3):186-92. doi: 10.1046/j.1525-1497.2002.10741.x.
• Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007 Feb 28;297(8):831-41. doi: 10.1001/jama.297.8.831.
• Maslove DM, Leiter RE, Griesman J, Arnott C, Mourad O, Chow CM, Bell CM. Electronic versus dictated hospital discharge summaries: a randomized controlled trial. J Gen Intern Med. 2009 Sep;24(9):995-1001. doi: 10.1007/s11606-009-1053-2. Epub 2009 Jul 16.

Study record dates

Study Major Dates

• Study Start: May 1, 2008
• Primary Completion (Actual): June 1, 2008
• Study Completion (Actual): July 1, 2008

Study Registration Dates

• First Submitted: April 7, 2008
• First Submitted That Met QC Criteria: April 30, 2008
• First Posted (Estimate): May 2, 2008

Study Record Updates

• Last Update Posted (Estimate): April 16, 2010
• Last Update Submitted That Met QC Criteria: April 15, 2010
• Last Verified: April 1, 2010

More Information

Terms related to this study

• Keywords: Quality improvement; Hospitalization; Continuity of care; Discharge summary; Medical records systems; Hospital information systems
• Other Study ID Numbers: 07-364