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The effect of diagnosis-specific computerized discharge instructions on 72-hour return visits to the pediatric
Laurie M Lawrence1, Cathy A Jenkins, Chuan Zhou
1Division of Pediatric Emergency Medicine, Department of Pediatrics, 703 Oxford House, Vanderbilt University Medical Center, Nashville, TN 37232, USA. laurie.lawrence@vanderbilt.edu
Insights
Computer-generated discharge instructions did not reduce unnecessary return visits to the pediatric emergency department (PED). This study found no significant difference in medically unnecessary revisits between handwritten and computer-generated instructions.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Patient Discharge Management
Background:
- Return visits to the pediatric emergency department (PED) within 72 hours are a quality benchmark.
- Reducing medically unnecessary revisits is a key healthcare objective.
Purpose of the Study:
- To evaluate if diagnosis-specific computer-generated discharge instructions decrease medically unnecessary return visits to the PED.
- To compare the effectiveness of computer-generated versus handwritten discharge instructions.
Main Methods:
- Retrospective chart review of PED return visits within 72 hours.
- Compared two periods: handwritten (Sept 2004-Feb 2005) vs. computer-generated (Sept 2005-Feb 2006) discharge instructions.
- Excluded specific cases and rated medical necessity of return visits.
Main Results:
- Unnecessary return visits were 13% with handwritten and 15% with computer-generated instructions (P=0.5, not significant).
- Older age and multiple prior return visits were associated with medically appropriate return visits.
- No statistically significant difference in unnecessary revisits was observed between instruction types.
Conclusions:
- Diagnosis-specific computer-generated discharge instructions do not reduce medically unnecessary repeat visits to the PED.
- Patient age and history of return visits influence the appropriateness of revisits.
Objective:
The number of patients returning to the pediatric emergency department (PED) within 72 hours of discharge is frequently cited as a benchmark for quality patient care. The purpose of this study was to determine whether the introduction of diagnosis-specific computer-generated discharge instructions would decrease the number of medically unnecessary return visits to the PED.
Methods:
A retrospective chart review of patients who returned to the PED within 72 hours of discharge was performed. Charts were reviewed from 2 comparable periods: September 2004 to February 2005, when handwritten discharge instructions were issued to each patient, and September 2005 to February 2006, when each patient received computer-generated diagnosis-specific discharge instructions. The patient's age, primary care provider, insurance status, chief complaint, vital signs, history, physical examination, plan of care, and diagnosis at each visit were recorded. Cases were excluded if the patient left against medical advice or without being seen, was admitted to the hospital on the first visit, or had incomplete or missing records. The medical necessity of the return visit was rated as "yes," "no," or "indeterminate" based on review of the visit noting reason for return, history and physical examination, diagnosis, and interventions or changes in the initial care plan.
Results:
Of all return visits to the PED within 72 hours of discharge, 13% were deemed unnecessary for patients receiving handwritten instructions compared with 15% for patients receiving computer-generated instructions (P = 0.5, not significant). For each additional year of age, the return visit was 1.07 times as likely to be medically appropriate (95% confidence interval, 1.03-1.12; P = 0.002). Patients who returned to the PED more than once were 2.69 times more likely to have a medically appropriate visit as were those with only 1 return visit (95% confidence interval, 0.95-7.58; P = 0.062).
Conclusions:
Computer-generated diagnosis-specific discharge instructions do not decrease the number of medically unnecessary repeat visits to the PED.
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