title: Compliance with emergency department referral: the effect of computerized discharge instructions.
abstract: 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.
authors: Department of Anesthesia/Critical Care Medicine, University of Pittsburgh Medical Center.
authors: R B
authors: RB
authors: Vukmir
authors: R
authors: R
authors: Kremen
authors: G L
authors: GL
authors: Ellis
authors: D A
authors: DA
authors: DeHart
authors: M C
authors: MC
authors: Plewa
authors: J
authors: J
authors: Menegazzi
mesh_terms: 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