Clinical trial NCT00670865: Automated Versus Conventional Hospital Discharge Summaries and Prescriptions
Official title: Automated Versus Conventional Hospital Discharge Summaries and Prescriptions: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Patient Discharge
Continuity of Patient Care
Medical Records Systems, Computerized
Hospital Information Systems
Keywords: Hospitalization
Continuity of care
Discharge summary
Quality improvement
Medical records systems
Hospital information systems
Lead sponsor: Unity Health Toronto
Sponsor class: OTHER
First posted: 2008-05-02
Enrollment: 209
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief 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.

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.

Eligibility criteria: 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

Primary outcomes:
measure: Primary care physician satisfaction from satisfaction score assessment form with 100-mm visual analogue scale
timeFrame: 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 outcomes:
measure: St. Michael's Hospital housestaff satisfaction from satisfaction score assessment form with 100-mm visual analogue scale
timeFrame: Housestaff will fill out form upon completion of the rotation during which the study has been performed
measure: Completion of specialist outpatient workups at St. Michael's Hospital recommended during course of hospitalization
timeFrame: Within the first 30 days of patient's discharge from hospital
measure: Patient visits to Emergency Room at St. Michael's Hospital
timeFrame: Within the first 30 days after patient's discharge from hospital
measure: Patient/proxy care transition assessment through the use of the CTM-3.
timeFrame: 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.
measure: Prescribing errors as assessed by comparing discharge summary to inpatient record
timeFrame: Upon discharge
measure: Patient readmissions to St. Michael's Hospital
timeFrame: Within 30 days of discharge
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: St. Michael's Hospital
state: Ontario
Study officials:
affiliation: Unity Health Toronto
name: David M Maslove, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: St. Michael's Hospital; University of Toronto
name: Chaim M Bell, MD, PhD, FRCPC
role: PRINCIPAL_INVESTIGATOR
References:
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.
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. doi: 10.1046/j.1525-1497.2002.10741.x.
citation: 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.
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.