Computer generated discharge summaries and their use as a case mix sensitive audit engine. A tale of two cities.
BACKGROUND
An 'audit engine' allows critical appraisal of clinical practice without necessitating cumbersome data input, editing or analysis. This is achieved by capturing data from an otherwise necessary task, in this case writing discharge summaries, and using standardised analyses to illustrate the effects of operational changes.


METHODS
Retrospective analysis of clinical outcome of 1,829 sequential discharges from one consultant's team in two geriatric medicine departments.


METHODS
Mortality, discharge destination and functional performance.


RESULTS
Median length of stay in the two departments differed significantly (8 vs 13 days; p < 0.0001), but patients in the latter department were more disabled, with almost twice as many needing domiciliary services after discharge and suffering impaired mobility or incontinence. Despite this disparity, a similar proportion of survivors was placed in institutional care (31/300 (10%) vs 94/1,100 (8%); NS).


CONCLUSIONS
This audit engine demonstrated that apparently worse performance indicators were explained by adverse case mix in one department, and the similar institutionalisation rates suggest superior care there.
Moseley Hall Hospital, Birmingham.
A
A
Ball
M
M
Goodman
L
L
Evans
E
E
Abrahall
J
J
Rowe
D000368:Aged; D003628:Database Management Systems; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D005260:Female; D005853:Geriatrics / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit / Q000379:methods*; D010351:Patient Discharge; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D006113:United Kingdom