Automated Versus Conventional Hospital Discharge Summaries and Prescriptions

This study has been completed.
Sponsor:
Information provided by:
St. Michael's Hospital, Toronto
ClinicalTrials.gov Identifier:
NCT00670865
First received: April 7, 2008
Last updated: April 15, 2010
Last verified: April 2010
  Purpose

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.


Condition Intervention
Patient Discharge
Continuity of Patient Care
Medical Records Systems, Computerized
Hospital Information Systems
Other: Electronic discharge summary system

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Automated Versus Conventional Hospital Discharge Summaries and Prescriptions: A Randomized Controlled Trial

Further study details as provided by St. Michael's Hospital, Toronto:

Primary Outcome Measures:
  • Primary care physician satisfaction from satisfaction score assessment form with 100-mm visual analogue scale [ Time Frame: 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. ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • St. Michael's Hospital housestaff satisfaction from satisfaction score assessment form with 100-mm visual analogue scale [ Time Frame: Housestaff will fill out form upon completion of the rotation during which the study has been performed ] [ Designated as safety issue: No ]
  • Completion of specialist outpatient workups at St. Michael's Hospital recommended during course of hospitalization [ Time Frame: Within the first 30 days of patient's discharge from hospital ] [ Designated as safety issue: No ]
  • Patient visits to Emergency Room at St. Michael's Hospital [ Time Frame: Within the first 30 days after patient's discharge from hospital ] [ Designated as safety issue: No ]
  • Patient/proxy care transition assessment through the use of the CTM-3. [ Time Frame: 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. ] [ Designated as safety issue: No ]
  • Prescribing errors as assessed by comparing discharge summary to inpatient record [ Time Frame: Upon discharge ] [ Designated as safety issue: No ]
  • Patient readmissions to St. Michael's Hospital [ Time Frame: Within 30 days of discharge ] [ Designated as safety issue: No ]

Enrollment: 209
Study Start Date: May 2008
Study Completion Date: July 2008
Primary Completion Date: June 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: eDischarge
The eDischarge arm will consist of two teams on the General Internal Medicine ward at St. Michael's Hospital who have been randomly assigned to use the electronic discharge summary program.
Other: Electronic discharge summary system
The customized electronic discharge summary program will be used to generate patient discharge summaries.
No Intervention: Traditional
The traditional arm will consist of two teams on the General Internal Medicine ward at St. Michael's Hospital who have been randomly assigned to use "traditional," dictated discharge summaries.

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

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
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
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00670865

Locations
Canada, Ontario
St. Michael's Hospital
Toronto, Ontario, Canada, M5B 1W8
Sponsors and Collaborators
St. Michael's Hospital, Toronto
Investigators
Principal Investigator: David M Maslove, MD St. Michael's Hospital, Toronto
Principal Investigator: Chaim M Bell, MD, PhD, FRCPC St. Michael's Hospital; University of Toronto