September 4, 2017BMC Health Services ResearchOpen Access

Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study

Q: What are the key findings of this study?

The introduction of a new electronic discharge system significantly increased the median completeness of mandatory discharge summary items from 60.7% to 75.0%.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Hospital discharge (n=773). Intervention: New electronic discharge system (NewEDS) vs. Pre-NewEDS (traditional discharge summaries). Primary outcome: Percentage completeness of 28 mandatory discharge summary items (p=<0.001).

Q: What does this research mean for the field?

The introduction of an electronic discharge system significantly improves the completeness and timeliness of hospital discharge communication. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

New electronic discharge system linked to a ~24% increase in mandatory discharge summary completeness.

P<0.001
n=773

Why the study?

Does the introduction of a new electronic discharge system improve the completeness and timeliness of discharge communication in patients discharged from an acute medical unit?

Population

773 patients discharged directly from the acute medical unit at Nottingham University Hospitals NHS Trust…

Comparison

Introduction of a new electronic discharge… vs Traditional forms of writing discharge summaries…

Design

Cohort, Not possible to blind the researchers as to which discharge summaries…

Authors

RMRajnikant MehtaUniversity of London BBBryn BaxendaleNottingham University Hospitals NHS Trust KRKatie Roth

Discussion

Member takes

Implication

NewEDS was associated with improved discharge communication; leaves open effects on readmissions or broader adoption.

Study Design

Type

Observational (n=773)

Multicenter

Structured PICO

Does the introduction of a new electronic discharge system improve the completeness and timeliness of discharge communication in patients discharged from an acute medical unit?

Population

773 patients discharged directly from an acute medical unit, evaluated before and after the introduction of a new electronic discharge system.

Intervention

Introduction of a new electronic discharge system (NewEDS) based on the Royal College of Physicians gold standard template.

Comparator

Traditional forms of writing discharge summaries (hand-written or dictated) prior to the introduction of the NewEDS.

Outcome

Percentage completeness (out of the 28 mandatory items from the Royal College of Physicians checklist).

Main Result

Absolute Event Rate: 75% vs 60.7%

Absolute Risk Reduction: 14.3%

p-value: p=<0.001

The introduction of a new electronic discharge system significantly improved the completeness and timeliness of hospital discharge communication compared to traditional methods.

Limitations

Researchers could not be blinded to the pre- or post-intervention status of the discharge summaries.
Potential for transcription errors during data collection.
Definition of timeliness may have underestimated the number of summaries completed within 24 hours.
Did not record the time needed to complete the discharge summaries.
Lacked subjective assessments of discharge summary quality by general practitioners.
Not possible to effectively blind the researchers, potentially subjecting reporting to bias.
Potential for transcription error from the original paper collection to the Excel spreadsheet.
Data collection defined only discharge summaries done on or before the day of discharge as timely, which may have under-estimated the number completed within the recommended 24 h period.

Cite This Study

Mehta et al. (2017) conducted an observational in Hospital discharge (n=773). New electronic discharge system (NewEDS) vs. Pre-NewEDS (traditional discharge summaries) was evaluated on Percentage completeness of 28 mandatory discharge summary items (p=<0.001). The introduction of a new electronic discharge system significantly increased the median completeness of mandatory discharge summary items from 60.7% to 75.0%.

synapsesocial.com/papers/6aa9ee10df35e3fdba843d6c https://doi.org/10.1186/s12913-017-2579-3

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