Patient satisfaction upon discharge improved
Patient satisfaction upon discharge improved
Hospitalists, PCPs use communication software
When hospitalists use discharge communication software, patients and the outpatient doctors who carry out the care have better perceptions of the quality of the discharge process, according to new research published in the August issue of the Journal of Hospital Medicine.1
Compared to standard systems, computerized physician order entry (CPOE) software:
- increased discharge preparedness scores from 17.2 to 17.7 for patients — a small but statistically significant increase;
- increased discharge quality scores from 16.5 to 17.2 for outpatient physicians — a small but statistically significant increase, but;
- decreased the "easiness" of the discharge workflow from 7.9 to 6.5 for hospitalists — a significant decrease.
James Graumlich, MD, associate professor of medicine and clinical pharmacology, chair in the department of medicine University of Illinois College of Medicine, is lead author of the study. Graumlich and his colleagues designed the software and studied the experience of 631 patients and 70 hospitalists who had used it between November 2004 and January 2007 in a teaching hospital in Illinois.
Seeking to improve communications
"We knew from studies that had been published before and a review done by AHRQ [Agency for Healthcare Research and Quality] that there was a problem with communication between hospitalists and primary care physicians [PCPs]," says Graumlich, explaining the rationale for creating the software. "It was suggested that these barriers to communication were causing adverse events and/or readmissions to occur within one month."
The current study, he continues, was specifically designed to see if the CPOE software would improve communications. "It was designed to include what were thought to be the ideal components of the discharge process as far as communication is concerned — medication reconciliation; letting the PCP know what tests were pending at the time of discharge; what tests were required as part of follow-up; and letting the patient know what the follow-up appointment date was," Graumlich says. "All of this had been previously published in guidelines, but they had not been studied to see if it made a difference."
In the study, he notes, half of the patients received the usual paper discharge instructions, while the other received them using the CPOE software.
On the network
During the study, Graumlich says, the software resided within the in-hospital network. "At the time of discharge, the doctor enters the information that's in the software — there are about six screens that provide prompts and cues to remind them to enter it," he explains. "The doctor does the ordering, and the output of the software goes to the nurse, who gives the discharge instructions to the patient and reviews it with them."
Since most of the PCP community did not have access to secure computer systems, he continues, they were faxed the discharge instructions, with a backup copy sent through the U.S. mail. "There are some systems where they simply receive an e-mail and up pops the discharge instructions," he notes.
Graumlich observes that the hospitalists who used the software were asked two questions; if they were satisfied with the discharge process, and how difficult their part of the process was. Interestingly, they rated the software as being more difficult. "A later study found it takes longer to enter data into the computer," he notes.
In a subsequent study published online this spring, Graumlich notes that there was no difference in adverse events, readmissions, or ED visits, "which surprised us." However, when he and his team looked at what other people had done in discharge interventions that had made a positive difference, "One used a pharmacist for post-discharge check-ups, and another used a discharge 'coach' and an advocate practical nurse as a 'discharge buddy,' and those showed important differences," he shares.
"We thought that improving communication by itself would make a difference [in outcomes]." Graumlich admits. "But it looks like with that personal touch the provider feels more ownership in processing that transition."
Reference
- Graumlich JF; Novotny NL; Nace GS; Aldag JC. Patient and Physician Perceptions After Software-Assisted Hospital AQ1 Discharge: Cluster Randomized Trial. J Hosp Med 2009; 4(6): DOI: 10.1002/jhm.565
[For more information, contact:
James Graumlich, MD, at (309) 655-7730.]
When hospitalists use discharge communication software, patients and the outpatient doctors who carry out the care have better perceptions of the quality of the discharge process, according to new research published in the August issue of the Journal of Hospital Medicine.Subscribe Now for Access
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