Efficacy of a Web-based Seamless Discharge Tool

• readmission to hospital [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
  The primary outcomes are identified as such because these are recognized to be major events that we are ultimately trying to prevent through safer health care. The 3 month time frame is felt to be most relevant, because it is short enough to potentially relate to discharge communications, but also long enough after discharge to permit some events to occur. The primary outcomes of interest will be assessed through existing linkages to hospitalization data from the Alberta Health Services Health Outcomes Group based in Calgary,for the outcome of readmission to acute care hospitals
  
  

• Post-discharge mortality [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
  The primary outcomes of interest will be assessed through existing linkages to data from the Alberta Vital Statistics for post-discharge mortality. Such an approach to post-discharge outcome ascertainment avoids the shortcoming of unreliable patient self-report on readmission, and the potential challenges associated with determining vital status of patients that we are unable to reach by telephone.
  
  

The vulnerability of the transition period has been attributed to three main factors. First, changes to patients'medication regimens during hospitalization are numerous, yet failure to reconcile discrepancies between admission and discharge is frequent. Second, the patient/family is required to take over care responsibilities at discharge and must often relay important information to the primary care physician. This can be particularly challenging if discharge information is poorly communicated, presented too rapidly, if instructions are verbal only, or if the patient has low literacy or low health literacy.Finally, crucial information is often not transferred between acute care physicians and community physicians.

Information about the hospitalization (such as medication changes, patient diagnoses, interventions,diagnostic findings, and necessary follow-up) is commonly transferred to the primary care physician via a discharge summary that is typically faxed or mailed. Unfortunately, deficits with respect to timeliness and/or complete failure to transmit are widespread. At the first post-discharge appointment, the discharge summary is unavailable to the primary care physician up to 75% of the time. This negatively impacts the continuity of care provided to many patients. When summaries are received, inconsistent content and inaccuracies are common. Acute care physicians, whether medical or surgical, often neglect to include diagnostic findings, treatment/hospital course, discharge medications, pending tests results, and whether the patient and family received counselling.

Computer-enabled discharge communications have potential to avert such problems. Such communication platforms can provide an immediate link between acute care and primary care physicians, and interfaces can be designed to ensure consistent information transfer. In addition, physicians in both settings have expressed preference for electronic discharge documents over hand written/dictated summaries with respect to clarity, comprehensiveness, and positive impacts on continuity of care.