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BMJ Qual Saf doi:10.1136/bmjqs.2009.034587
  • ORIGINAL RESEARCH

The efficacy of computer-enabled discharge communication interventions: a systematic review

  1. William A Ghali1,2,10
  1. 1Department of Community Health Sciences, University of Calgary, Calgary, Canada
  2. 2Medical Ward of the 21st Century, Foothills Medical Centre, Calgary, Canada
  3. 3Department of Critical Care Medicine, University of Calgary, Calgary, Canada
  4. 4LiKaShing Knowledge Institute at St Michael's, Toronto, Canada
  5. 5University of Toronto, Toronto, Canada
  6. 6Division of General Internal Medicine and Center of Excellence for Patient Safety Research and Practice, Brigham and Women's Hospital Boston, Massachusetts, USA
  7. 7The Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
  8. 8Centre for Health and Policy Studies, University of Calgary, Calgary, Canada
  9. 9Institute of Health Economics, University of Calgary, Calgary, Canada
  10. 10Department of Medicine University of Calgary, Calgary, Canada
  1. Correspondence to Soror Mona Motamedi, W21C Research and Innovation Centre, GD01 TRW Building, 3280 Hospital Drive, Calgary, Alberta, Canada NW T2N 4Z6; Mona.Motamedi{at}AlbertaHealthServices.ca
  • Accepted 6 December 2010
  • Published Online First 24 January 2011

Abstract

Context Traditional manual/dictated discharge summaries are inaccurate, inconsistent and untimely. Computer-enabled discharge communications may improve information transfer by providing a standardised document that immediately links acute and community healthcare providers.

Objective To conduct a systematic review evaluating the efficacy of computer-enabled discharge communication compared with traditional communication for patients discharged from acute care hospitals.

Data sources MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials and MEDLINE In-Process. Keywords from three themes were combined: discharge communication, electronic/online/web-based and controlled interventional studies.

Study selection Study types included: clinical trials, quasiexperimental studies with concurrent controls and controlled before–after studies. Interventions included: (1) automatic population of a discharge document by computer database(s); (2) transmission of discharge information via computer technology; or (3) computer technology providing a ‘platform’ for dynamic discharge communication. Controls included: no intervention or traditional manual/dictated discharge summaries. Primary outcomes included: mortality, readmission and adverse events/near misses. Secondary outcomes included: timeliness, accuracy, quality/completeness and physician/patient satisfaction.

Data extraction Description of interventions and study outcomes were extracted by two independent reviewers.

Results 12 unique studies were identified: eight randomised controlled trials and four quasi-experimental studies. Pooling/meta-analysis was not possible, given the heterogeneity of measures and outcomes reported. The primary outcomes of mortality and readmission were inconsistently reported. There was no significant difference in mortality, and one study reported reduced long-term readmission. Intervention groups experienced reductions in perceived medical errors/adverse events, and improvements in timeliness and physician/patient satisfaction.

Conclusions Computer-enabled discharge communications appear beneficial with respect to a number of important secondary outcomes. Primary outcomes of mortality and readmission are less commonly reported in this literature and require further study.

Footnotes

  • Funding Alberta Innovates - Health Solutions.

  • Competing interests None.

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

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