Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial.
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.
Graumlich
James F
JF
Department of Medicine, University of Illinois College of Medicine, Peoria, Illinois, USA. jfg@uic.edu
Novotny
Nancy L
NL
Stephen Nace
G
G
Kaushal
Himangi
H
Ibrahim-Ali
Waleed
W
Theivanayagam
Shoba
S
William Scheibel
L
L
Aldag
Jean C
JC
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