ABSTRACT
BACKGROUND
Patient care transitions are periods of enhanced risk. Discharge summaries have been used to communicate essential information between hospital-based physicians and primary care physicians (PCPs), and may reduce rates of adverse events after discharge.
OBJECTIVE
To assess PCP satisfaction with an electronic discharge summary (EDS) program as compared to conventional dictated discharge summaries.
DESIGN
Cluster randomized trial.
PARTICIPANTS
Four medical teams of an academic general medical service.
MEASUREMENTS
The primary endpoint was overall discharge summary quality, as assessed by PCPs using a 100-point visual analogue scale. Other endpoints included housestaff satisfaction (using a 100-point scale), adverse outcomes after discharge (combined endpoint of emergency department visits, readmission, and death), and patient understanding of discharge details as measured by the Care Transition Model (CTM-3) score (ranging from 0 to 100).
RESULTS
209 patient discharges were included over a 2-month period encompassing 1 housestaff rotation. Surveys were sent out for 188 of these patient discharges, and 119 were returned (63% response rate). No difference in PCP-reported overall quality was observed between the 2 methods (86.4 for EDS vs. 84.3 for dictation; P = 0.53). Housestaff found the EDS significantly easier to use than conventional dictation (86.5 for EDS vs. 49.2 for dictation; P = 0.03), but there was no difference in overall housestaff satisfaction. There was no difference between discharge methods for the combined endpoint for adverse outcomes (22 for EDS [21%] vs. 21 for dictation [20%]; P = 0.89), or for patient understanding of discharge details (CTM-3 score 80.3 for EDS vs. 81.3 for dictation; P = 0.81)
CONCLUSION
An EDS program can be used by housestaff to more easily create hospital discharge summaries, and there was no difference in PCP satisfaction.
Similar content being viewed by others
References
van Walraven C, Taljaard M, Bell CM, et al. Information exchange among physicians caring for the same patient in the community. CMAJ. 2008;179:1013–8.
van Walraven C, Rokosh E. What is necessary for high-quality discharge summaries? Am J Med Qual. 1999;14:160–9.
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;17:186–92.
Moore C, McGinn T, Halm E. Tying up loose ends: Discharging patients with unresolved medical issues. Arch Intern Med. 2007;167:1305–11.
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;297:831–41.
Tulloch AJ, Fowler GH, McMullan JJ, Spence JM. Hospital discharge reports: content and design. BMJ. 1975;4(5994):443–6.
Mageean RJ. Study of "discharge communications" from hospital. BMJ (Clin Res Ed). 1986;293(6557):1283–4.
van Walraven C, Weinberg AL. Quality assessment of a discharge summary system. CMAJ. 1995;152:1437–42.
Macaulay EM, Cooper GG, Engeset J, Naylor AR. Prospective audit of discharge summary errors. Br J Surg. 1996;83:788–90.
O’Leary KJ, Liebovitz DM, Feinglass J, Liss D, Baker DW. Outpatient physicians’ satisfaction with discharge summaries and perceived need for an electronic discharge summary. J Hospital Med. 2006;1:317–20.
van Walraven C, Laupacis A, Seth R, Wells G. Dictated versus database-generated discharge summaries: a randomized clinical trial. CMAJ. 1999;160:319–26.
Lissauer T, Paterson CM, Simons A, Beard RW. Evaluation of computer generated neonatal discharge summaries. Arch Dis Child. 1991;66:433–6.
Llewelyn DE, Ewins DL, Horn J, Evans TGR, McGregor AM. Computerised updating of clinical summaries: new opportunities for clinical practice and research? BMJ. 1988;297(6662):1504–6.
Smith RP, Holzman GB. The application of a computer data base system to the generation of hospital discharge summaries. Obstet Gynecol. 1989;73:803–7.
O’Leary KJ, Liebovitz DM, Feinglass J, et al. Creating a better discharge summary: Improvement in quality and timeliness using an electronic discharge summary. J Hosp Med. 2009;4:219–25.
Callen JL, Alderton M, McIntosh J. Evaluation of electronic discharge summaries: a comparison of documentation in electronic and handwritten discharge summaries. Int J Med Informatics. 2008;77:613–20.
Weir CR, Nebeker JR. Critical issues in an electronic documentation system. AMIA Annu Symp Proc. 2007;11:786–90.
Van Walraven C, Mamdani M, Fang J, Austin PC. Continuity of care and patient outcomes after hospital discharge. J Gen Intern Med. 2004;19:624–31.
Parry C, Mahoney E, Chalmers S, Coleman EA. Assessing the quality of transitional care: further applications of the Care Transitions Measure. Med Care. 2008;46:3137–322. Details of score available at www.caretransitions.org/documents/CTM3Specs0807.pdf (accessed May 21, 2009).
Kerry SM, Bland JM. The intracluster correlation coefficient in cluster randomisation. BMJ. 1998;316(7142):1455.
O’Donnell HC, Kaushal R, Barron Y, Callahan MA, Adelman RD, Siegler EL. Physicians attitudes towards copy and pasting in electronic note writing. J Gen Intern Med. 2008;24:63–8.
Acknowledgements
Dr. Bell is supported by a Canadian Institutes of Health Research and Canadian Patient Safety Institute chair in Patient Safety and Continuity of Care. This study was funded by the University Of Toronto Chair of Medicine Quality Partners Program, and by a summer student grant from Li Ka-Shing Knowledge Institute, and Keenan Research Centre, St. Michael’s Hospital. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. Our thanks to the Information Technology department at St. Michael’s Hospital for their help and support, and to Dr. Rosane Nisenbaum (Keenan Research Center), who provided additional statistical analysis.
Conflicts of Interest
The authors declare no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maslove, D.M., Leiter, R.E., Griesman, J. et al. Electronic Versus Dictated Hospital Discharge Summaries: a Randomized Controlled Trial. J GEN INTERN MED 24, 995–1001 (2009). https://doi.org/10.1007/s11606-009-1053-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-009-1053-2