Compliance with emergency department referral: the effect of computerized discharge instructions.
OBJECTIVE
To examine the effect of computerized discharge instructions on emergency department patient referral recommendations.


METHODS
Prospective, descriptive analysis and clinical trial.


METHODS
Emergency medicine residency-affiliated urban hospital with 568 beds and 29,000 annual visits.


METHODS
One thousand ED patients discharged to an outpatient referral network during a six-week period.


METHODS
Mandatory referral was provided in written or computerized (Logicare Corp, Eau Claire, Wisconsin) format for each 500-patient group. Demographic data and compliance, measured as appointment completion within 30 days, were analyzed using chi 2 with Yates' correction, Fisher's exact, and odds ratio comparisons (P < .05, 95% confidence interval).


RESULTS
The institution of computerized discharge instructions resulted in increased overall patient compliance from 26.2% to 36.2% (P < .0008) with odds ratio of 1.59 (1.2 to 2.1). Subset analysis showed increased compliance in patients who were more than 40 years old (32.5% to 61.1%), were female (28.7% to 39.7%) with a private physician (36.4% to 53.9%), established hospital relationship (26.1% to 38.9%), had nonurgent complaints (26.5% to 36.2%), were specifically diagnosed with strain or contusion (17.0% to 36.8%), or were referred to obstetrics/gynecology clinic (13.2% to 48.6%) (P < .001).


CONCLUSIONS
Computerized discharge instructions were associated with improved compliance with ED referral recommendations, based on historic and contemporary controls.
Vukmir
R B
RB
Department of Anesthesia/Critical Care Medicine, University of Pittsburgh Medical Center.
Kremen
R
R
Ellis
G L
GL
DeHart
D A
DA
Plewa
M C
MC
Menegazzi
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006751:Hospital Information Systems; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010349:Patient Compliance; D010351:Patient Discharge; D010414:Pennsylvania; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data