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. 2017 Sep 5;17(1):624.
doi: 10.1186/s12913-017-2579-3.

Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study

Rajnikant L Mehta  1 , Bryn Baxendale  2 , Katie Roth  3 , Victoria Caswell  3 , Ivan Le Jeune  2 , Jack Hawkins  4 , Haya Zedan  5 , Anthony J Avery  3
Affiliations

Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study

Rajnikant L Mehta et al. BMC Health Serv Res. .

Abstract

Background: Hospital discharge summaries are a key communication tool ensuring continuity of care between primary and secondary care. Incomplete or untimely communication of information increases risk of hospital readmission and associated complications. The aim of this study was to evaluate whether the introduction of a new electronic discharge system (NewEDS) was associated with improvements in the completeness and timeliness of discharge information, in Nottingham University Hospitals NHS Trust, England.

Methods: A before and after longitudinal study design was used. Data were collected using the gold standard auditing tool from the Royal College of Physicians (RCP). This tool contains a checklist of 57 items grouped into seven categories, 28 of which are classified as mandatory by RCP. Percentage completeness (out of the 28 mandatory items) was considered to be the primary outcome measure. Data from 773 patients discharged directly from the acute medical unit over eight-week long time periods (four before and four after the change to the NewEDS) from August 2010 to May 2012 were extracted and evaluated. Results were summarised by effect size on completeness before and after changeover to NewEDS respectively. The primary outcome variable was represented with percentage of completeness score and a non-parametric technique was used to compare pre-NewEDS and post-NewEDS scores.

Results: The changeover to the NewEDS resulted in an increased completeness of discharge summaries from 60.7% to 75.0% (p < 0.001) and the proportion of summaries created under 24 h from discharge increased significantly from 78.0% to 93.0% (p < 0.001). Furthermore, five of the seven grouped checklist categories also showed significant improvements in levels of completeness (p < 0.001), although there were reduced levels of completeness for three items (p < 0.001).

Conclusion: The introduction of a NewEDS was associated with a significant improvement in the completeness and timeliness of hospital discharge communication.

Keywords: Completeness; Discharge summaries; Gold standard auditing tool; New electronic discharge system.

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Conflict of interest statement

Ethics approval and consent to participate

This study was considered to be under the umbrella of a larger service evaluation, reference CfHEP005. The CfHEP005 was considered by the East London and The City Research Ethics Committee 1 and approval granted. Furthermore, researchers obtained Research and Development approval from Nottingham University Hospital NHS Trust and Nottinghamshire County Teaching Primary Care Trust. No patient identifiable data emanating from the study were recorded.

Consent for publication

This is not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart depicting process and assessing agreement
Fig. 2
Fig. 2
Mean percentage completeness scores of items considered mandatory by the Royal College of Physicians. formula image Ward B formula image Ward D57 formula image Combined
Fig. 3
Fig. 3
Discharge summaries created within 24 hours of a patient being discharged across the eight time periods. formula image Ward B formula image Ward D57 formula image Combined
See this image and copyright information in PMC

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