Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: Cluster randomized trial

• Published in: Journal of hospital medicine 2009-09, Vol.4 (7), p.E11-E19
• Main Authors: Graumlich, James F., Novotny, Nancy L., Stephen Nace, G., Kaushal, Himangi, Ibrahim-Ali, Waleed, Theivanayagam, Shoba, William Scheibel, L., Aldag, Jean C.
• Format: Article
• Language: English
• Subjects: Cluster Analysis; continuity of patient care; Continuity of Patient Care - organization & administration; electronic discharge summary; Emergency Service, Hospital - utilization; Female; health care surveys; hospital information systems; hospitalists; Humans; Male; Medical Records Systems, Computerized; medication reconciliation; patient care transitions; patient discharge; Patient Discharge - standards; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Patient Satisfaction; Sample Size; Software
• ISSN: 1553-5592; 1553-5606
• DOI: 10.1002/jhm.469

BACKGROUND: One of the causes of postdischarge adverse events is poor discharge communication between hospital‐based physicians, patients, and outpatient physicians. The value of hospital discharge software to improve communication and clinically relevant outcomes is unknown. OBJECTIVE: To measure effects of a discharge software application of computerized physician order entry (CPOE). DESIGN: Cluster randomized controlled trial. SETTING: Tertiary care, teaching hospital in central Illinois. PATIENTS: A total of 631 inpatients discharged to home with high risk for readmission. INTERVENTION: Seventy internal medicine hospital physicians were randomly assigned (allocation concealed) to discharge software versus usual care, handwritten discharge. MEASUREMENTS: Blinded assessment of patient readmission, emergency department visit, and postdischarge adverse event. RESULTS: A total of 590 (94%) patients provided 6‐month follow‐up data. Generalized estimating equations gave intervention variable coefficients with 95% confidence interval (CI). When comparing patients assigned to discharge software versus usual care, there was no difference in hospital readmission within 6 months (37.0% versus 37.8%; coefficient −0.005 [95% CI, −0.074 to 0.065]; P = 0.894), emergency department visit within 6 months (35.4% versus 40.6%; coefficient −0.052 [95% CI, −0.115 to 0.011]; P = 0.108), or adverse event within 1 month (7.3% versus 7.3%; coefficient 0.003 [95% CI; −0.037 to 0.043]; P = 0.884). CONCLUSIONS: Discharge software with CPOE did not affect readmissions, emergency department visits, or adverse events after discharge. Future studies should assess other endpoints such as patient perceptions or physician perceptions to see if discharge software has value. Journal of Hospital Medicine 2009;4:E11–E19. © 2009 Society of Hospital Medicine.