Automated Versus Conventional Hospital Discharge Summaries and Prescriptions - Full Text View

Sponsored by:	St. Michael's Hospital, Toronto
Information provided by:	St. Michael's Hospital, Toronto
ClinicalTrials.gov Identifier:	NCT00670865

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:	Health Services Research, Randomized, Open Label, Parallel Assignment
Official Title:	Automated Versus Conventional Hospital Discharge Summaries and Prescriptions: A Randomized Controlled Trial

Resource links provided by NLM:

MedlinePlus related topics: Personal Medical Records

U.S. FDA Resources

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 ]

Estimated Enrollment:	204
Study Start Date:	May 2008
Estimated Study Completion Date:	July 2008
Estimated Primary Completion Date:	June 2008 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
eDischarge: Experimental 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.
Traditional: No Intervention 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

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

More Information

Publications:

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.

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.

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. Review.

Responsible Party:	St. Michael's Hospital ( David Maslove, MD. Chief Medical Resident )
Study ID Numbers:	07-364
Study First Received:	April 7, 2008
Last Updated:	July 14, 2008
ClinicalTrials.gov Identifier:	NCT00670865 History of Changes
Health Authority:	Canada: Ethics Review Committee

Keywords provided by St. Michael's Hospital, Toronto:

Hospitalization
Continuity of care
Discharge summary

Quality improvement
Medical records systems
Hospital information systems

ClinicalTrials.gov processed this record on September 03, 2009