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Compliance with emergency department referral: the effect of computerized discharge instructions
R B Vukmir1, R Kremen, G L Ellis
1Department of Anesthesia/Critical Care Medicine, University of Pittsburgh Medical Center.
Insights
Computerized discharge instructions significantly improved patient adherence to emergency department (ED) referrals. This digital approach enhanced compliance across various patient demographics and conditions.
Area of Science:
- Health Services Research
- Emergency Medicine
- Health Informatics
Background:
- Effective patient follow-up is crucial after emergency department (ED) visits.
- Traditional discharge instructions may have limitations in ensuring patient comprehension and compliance.
- Digital health tools offer potential for improving healthcare communication and outcomes.
Purpose of the Study:
- To evaluate the impact of computerized discharge instructions on patient compliance with outpatient referrals.
- To compare the effectiveness of computerized versus traditional written discharge instructions.
- To identify patient subgroups that benefit most from computerized discharge instructions.
Main Methods:
- Prospective, descriptive analysis and clinical trial conducted at an urban hospital.
- One thousand emergency department patients were assigned to receive either written or computerized discharge instructions.
- Compliance was measured by appointment completion within 30 days and analyzed using statistical methods including chi-squared and odds ratio comparisons.
Main Results:
- Overall patient compliance increased from 26.2% to 36.2% with computerized discharge instructions (P < .0008).
- Significant compliance improvements were observed in patients over 40, females, those with private physicians, and established hospital relationships.
- Increased compliance was also noted for nonurgent complaints, specific diagnoses (strain/contusion), and referrals to obstetrics/gynecology.
Conclusions:
- Computerized discharge instructions are associated with improved patient compliance with emergency department referral recommendations.
- The study provides evidence supporting the use of digital tools to enhance post-discharge care and follow-up.
- Targeted interventions using computerized instructions may optimize referral adherence in specific patient populations.
Study Objective:
To examine the effect of computerized discharge instructions on emergency department patient referral recommendations.
Design:
Prospective, descriptive analysis and clinical trial.
Setting:
Emergency medicine residency-affiliated urban hospital with 568 beds and 29,000 annual visits.
Type Of Participants:
One thousand ED patients discharged to an outpatient referral network during a six-week period.
Intervention:
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).
Measurements And Main 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).
Conclusion:
Computerized discharge instructions were associated with improved compliance with ED referral recommendations, based on historic and contemporary controls.