Information Technology Improves Emergency Department Patient Discharge Instructions Completeness and Performance on a National Quality Measure

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This is a first review of the article "Information Technology Improves Emergency Department Patient Discharge Instructions Completeness and Performance on a National Quality Measure." [1]

Background

In US there were roughly 130 million ED visits in 2010. Out of these visits, roughly 87% were discharged home with discharge instructions. Discharge instructions with medication discrepancies or which are deficient in important patient information results in poor patient outcomes and increase resource utilization post discharge. Discharge summaries containing following criteria: principal diagnosis or chief complaint; major procedures and tests performed; patient care instructions; follow-up instructions; and new or changed medications are considered adequate discharge instructions. Centers of Medicare and Medicaid Services (CMS) developed Outpatient Measure 19 (OP-19) that includes all of these above criteria. Information technology is believed to improve the quality of discharge instructions. This study was done to evaluate the completeness of electronic discharge instructions after such a module was developed and implemented in the Electronic Health Records (EHRs) used in the study hospital using this CMS quality measure OP-19 as the benchmark.

Methods

Brigham and Women’s Hospital in Boston developed an electronic discharge instructions module, which was implemented in May 2012. This study was done to compare the quality of discharge instructions of random ED discharges from two time periods, pre and post-implementation of this module. A total of 300 patients, 150 each in two groups were randomly selected from a period of pre and post-implementation of the discharge instruction module. The selected patients, in short to be eligible for the study, had to have completed evaluation in the ED and were discharged home.

Results

Overall compliance for paper based and electronic discharge instructions with CMS measure OP-19 was 46.7% (70/150) and 97.3% (146/150). 40% of the paper based discharge instructions lacked major procedures and tests performed section, whereas all 4 of the incomplete electronic discharge instructions lacked patient instructions.

Comments

This study shows the impact of health information technology in improving the discharge instructions. Electronically created discharge instructions allow easy inclusion of the test results and therefore resulted in producing complete discharge instructions. In the, as fragmented as it could be, healthcare environment in US, a complete discharge instruction, may result in decreased resource utilization post ED visit but this remains to be proven.

References

  1. Bell, E. J., Takhar, S. S., Beloff, J. R., Schuur, J. D., & Landman, A. B. (2013). Information Technology Improves Emergency Department Patient Discharge Instructions Completeness and Performance on a National Quality Measure: A Quasi-Experimental Study. Applied Clinical Informatics, 4(4), 499–514. http://doi.org/10.4338/ACI-2013-07-RA-0046