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A randomised controlled trial assessing the efficacy of an electronic discharge communication tool for preventing death or hospital readmission
  1. Maria J Santana1,
  2. Jayna Holroyd-Leduc1,2,
  3. Danielle A Southern1,
  4. Ward W Flemons2,
  5. Maeve O’Beirne3,
  6. Michael D Hill1,2,4,
  7. Alan J Forster5,
  8. Deborah E White6,
  9. William A. Ghali7
  10. the e-DCT Team
  1. 1 Department of Community Health Sciences, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2 Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3 Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  5. 5 Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  6. 6 Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
  7. 7 Departments of Community Health Sciences and Medicine, and the Calgary Institute for Population and Public Health, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr. Maria J Santana, Department of Community Health Sciences, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; mjsantan{at}ucalgary.ca

Abstract

Objective To assess the efficacy of an electronic discharge communication tool (e-DCT) for preventing death or hospital readmission, as well as reducing patient-reported adverse events after hospital discharge. The e-DCT assessed has already been shown to yield high-quality discharge summaries with high levels of patient and physician satisfaction.

Methods This two-arm randomised controlled trial was conducted in a Canadian tertiary care centre’s internal medicine medical teaching units. Out of the 1953 patients approached and screened for inclusion, 1399 were randomised and available for data linkage for determination of the primary outcome. Participants were randomly assigned to e-DCT versus usual care (traditional discharge communication generated by dictation). The primary outcome was a composite of death or readmission within 90 days. The secondary outcome included any patient-reported adverse events within 30 days of discharge.

Results Among 1399 randomised participants, 230 of 701 participants (32.8%) in the e-DCT group experienced the primary composite outcome of death or readmission within 90 days vs 205 of 698 participants (29.4%) in the usual care group (p=0.166). The incidence at 30 days of patient-reported adverse outcomes (35% for e-DCT vs 34% for usual care) and adverse events (2.1% for e-DCT vs 1.8% for usual care) also did not differ significantly between groups.

Conclusions The e-DCT tested did not reduce the composite endpoint of death or readmission at 90 days, nor the incidence of patient-reported adverse events at 30 days. This neutral finding for hard clinical endpoints needs to be considered in the context of high patient and physician satisfaction, and high quality of discharge summaries.

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Footnotes

  • Contributors Drs. Santana and Ghali had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.All authors satisfy the criteria for authorship relating to study concept and design, acquisition and analysis of data, drafting and revising the manuscript, statistical analysis, funding and materials support and study supervision. Studyconcept and design: Ghali,Holroyd-Leduc, O’Brien, Flemons, White and Forster Dataacquisition included research assistants: Okonieswka, Clayden,Skora, Raissi, Ocampo, Dahodwala and de Grood. Drafting of the manuscript: Santana,Southern, Ghali. Critical revision of the manuscript for intellectualcontent: all authors. Statistical analysis: Southern, Santana, Ghali. Obtained funding: Ghali, Holroyd-Leduc,O’Brien, Flemons, White and Forster Administrative, technical, or material support: Steinke and de Grood. Study supervision: Santana, Ghali, Holroyd-Leduc,O’Brien, Flemons, Hill, White and ForsterAll authors have read and approved the final paper.

  • Competing interests None declared.

  • Patient consent This article does not contain personal medical information about an identifiable living individual, and therefore does not require the patient’s explicit consent before we can publish it.

  • Ethics approval The study was approved by the Conjoint Health Research Ethics Board at the University of Calgary.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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