title: Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial.
abstract: BACKGROUND
  One of the causes of postdischarge adverse events is poor discharge communication between hospital-based physicians, patients, and outpatient physicians. The value of hospital discharge software to improve communication and clinically relevant outcomes is unknown.
  
  
  OBJECTIVE
  To measure effects of a discharge software application of computerized physician order entry (CPOE).
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  Tertiary care, teaching hospital in central Illinois.
  
  
  METHODS
  A total of 631 inpatients discharged to home with high risk for readmission.
  
  
  METHODS
  Seventy internal medicine hospital physicians were randomly assigned (allocation concealed) to discharge software versus usual care, handwritten discharge.
  
  
  METHODS
  Blinded assessment of patient readmission, emergency department visit, and postdischarge adverse event.
  
  
  RESULTS
  A total of 590 (94%) patients provided 6-month follow-up data. Generalized estimating equations gave intervention variable coefficients with 95% confidence interval (CI). When comparing patients assigned to discharge software versus usual care, there was no difference in hospital readmission within 6 months (37.0% versus 37.8%; coefficient -0.005 [95% CI, -0.074 to 0.065]; P = 0.894), emergency department visit within 6 months (35.4% versus 40.6%; coefficient -0.052 [95% CI, -0.115 to 0.011]; P = 0.108), or adverse event within 1 month (7.3% versus 7.3%; coefficient 0.003 [95% CI; -0.037 to 0.043]; P = 0.884).
  
  
  CONCLUSIONS
  Discharge software with CPOE did not affect readmissions, emergency department visits, or adverse events after discharge. Future studies should assess other endpoints such as patient perceptions or physician perceptions to see if discharge software has value.
authors.affiliation: Department of Medicine, University of Illinois College of Medicine, Peoria, Illinois, USA. jfg@uic.edu
authors.forename: James F
authors.initials: JF
authors.lastname: Graumlich
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Novotny
authors.forename: G
authors.initials: G
authors.lastname: Stephen Nace
authors.forename: Himangi
authors.initials: H
authors.lastname: Kaushal
authors.forename: Waleed
authors.initials: W
authors.lastname: Ibrahim-Ali
authors.forename: Shoba
authors.initials: S
authors.lastname: Theivanayagam
authors.forename: L
authors.initials: L
authors.lastname: William Scheibel
authors.forename: Jean C
authors.initials: JC
authors.lastname: Aldag
mesh_terms: D016000:Cluster Analysis; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D018401:Sample Size; D012984:Software