Summary
Objectives: To compare the completeness of Emergency Department (ED) discharge instructions before
and after introduction of an electronic discharge instructions module by scoring compliance
with the Centers for Medicare and Medicaid Services (CMS) Outpatient Measure 19 (OP-19).
Methods: We performed a quasi-experimental study examining the impact of an electronic discharge
instructions module in an academic ED. Three hundred patients discharged home from
the ED were randomly selected from two time intervals: 150 patients three months before
and 150 patients three to five months after implementation of the new electronic module.
The discharge instructions for each patient were reviewed, and compliance for each
individual OP-19 element as well as overall OP-19 compliance was scored per CMS specifications.
Compliance rates as well as risk ratios (RR) and risk differences (RD) with 95% confidence
intervals (CI) comparing the overall OP-19 scores and individual OP-19 element scores
of the electronic and paper-based discharge instructions were calculated.
Results: The electronic discharge instructions had 97.3% (146/150) overall OP-19 compliance,
while the paper-based discharge instructions had overall compliance of 46.7% (70/150).
Electronic discharge instructions were twice as likely to achieve overall OP-19 compliance
compared to the paper-based format (RR: 2.09, 95% CI: 1.75 – 2.48). The largest improvement
was in documentation of major procedures and tests performed: only 60% of the paper-based
discharge instructions satisfied this criterion, compared to 100% of the electronic
discharge instructions (RD: 40.0%, 95% CI: 32.2% – 47.8%). There was a modest difference
in medication documentation with 92.7% for paper-based and 100% for electronic formats
(RD: 7.3%, 95% CI: 3.2% – 11.5%). There were no statistically significant differences
in documentation of patient care instructions and diagnosis between paper-based and
electronic formats.
Conclusions: With careful design, information technology can improve the completeness of ED patient
discharge instructions and performance on the OP-19 quality measure.
Citation: Bell EJ, Takhar SS, Beloff JR, Schuur JD, Landman AB. Information technology improves
emergency department patient discharge instructions completeness and performance on
a national quality measure: A quasi-experimental study. Appl Clin Inf 2013; 4: 499–514
http://dx.doi.org/10.4338/ACI-07-RA-0046
Keywords
Computerized medical records systems - emergency care information systems - patient
discharge - quality improvement - health care reform
