Automated Versus Conventional Hospital Discharge Summaries and Prescriptions

Patient Discharge Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00670865
• Other study ID #: 07-364
• Status: Completed
• Phase: N/A
• First received: April 7, 2008
• Last updated: April 15, 2010
• Start date: May 2008
• Est. completion date: July 2008

Study information

• Verified date: April 2010
• Source: St. Michael's Hospital, Toronto
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Ethics Review Committee
• Study type: Interventional

Clinical Trial Summary

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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 209
• Est. completion date: July 2008
• Est. primary completion date: June 2008
• Accepts healthy volunteers: No
• Gender: Both
• Age group: N/A and older

Eligibility

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 Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Continuity of Patient Care
• Hospital Information Systems
• Medical Records Systems, Computerized
• Patient Discharge

Intervention

Other:
• Electronic discharge summary system
The customized electronic discharge summary program will be used to generate patient discharge summaries.

Locations

Country	Name	City	State
Canada	St. Michael's Hospital	Toronto	Ontario

Sponsors (1)

Lead Sponsor	Collaborator
St. Michael's Hospital, Toronto

Country where clinical trial is conducted

Canada, 

References & Publications (4)

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. Review. — View Citation

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. — View Citation

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. — View Citation

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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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.	No
Secondary	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	No
Secondary	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	No
Secondary	Patient visits to Emergency Room at St. Michael's Hospital		Within the first 30 days after patient's discharge from hospital	No
Secondary	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.	No
Secondary	Prescribing errors as assessed by comparing discharge summary to inpatient record		Upon discharge	No
Secondary	Patient readmissions to St. Michael's Hospital		Within 30 days of discharge	No