In the transition from inpatient to outpatient care, when patients are vulnerable to adverse events, it is important to have good discharge communication. However, a recent trial of discharge software with computerized physician order entry found only small improvements in discharge perceptions by patients and their outpatient physicians, according to James F. Graumlich, M.D., of the University of Illinois College of Medicine, and colleagues.
They surveyed perceptions of discharge preparedness among 631 inpatients from an Illinois teaching hospital who were discharged home with a high risk of readmission, as well as their internal medicine hospital physicians and outpatient physicians. They then compared patients assigned to the discharge software group with those who were not. The discharge software produced concise reports and outlined a brief postdischarge care plan. The discharge summary included discharge diagnoses, key findings, test results, followup appointments, pending diagnostic tests, documentation of patient education, a reconciled medication list, and contact information for the hospital physician.
Patients' perceptions of their discharge preparedness were slightly higher for those in the software group (mean of 17.7 vs. 17.2), but their scores for satisfaction with medication information were unchanged (12.3 vs. 12.1). Outpatient physicians of patients in the software group perceived only slightly higher quality discharge than those in the nonsoftware group (17.2 vs. 16.5). This may have been because discharge plans and prescriptions were transmitted mostly by fax, since most of the community physicians had no access to interoperable medical records, secure messaging, or electronic transmittal of prescriptions.
Hospital physicians reported significantly more effort involved in using the discharge software than the effort for usual care (6.5 vs. 7.9). This may have been because the software application was not integrated with the hospital electronic medical record (EMR) and hospital physicians had to reenter patient data already in EMR, suggest the researchers. Their study was supported by the Agency for Healthcare Research and Quality (HS15084).
See "Patient and physician perceptions after software-assisted hospital discharge: Cluster randomized trial," by Dr. Graumlich, Nancy L. Novotny, Ph.D., G. Stephen Nace, M.D., and Jean C. Aldag, Ph.D., in the Journal of Hospital Medicine 4(6), pp. 356-363, 2009.