Is email an effective method for hospital discharge communication? A randomized controlled trial to examine delivery of computer-generated discharge summaries by email, fax, post and patient hand delivery

https://doi.org/10.1016/j.ijmedinf.2009.12.006Get rights and content

Abstract

Objective

To examine the effectiveness of delivering of computer-generated discharge summaries to general practice by email, fax, post and patient hand delivery.

Design

Blinded, randomized controlled trial. A pre-study audit ascertaining baseline statistics and a follow-up survey were conducted with general practice to determine preferred medium for receiving discharge communication.

Participants and setting

196 geriatric patients who were admitted to the aged care ward of a 300-bed metropolitan teaching hospital. Twenty-eight patients were lost to follow-up and 52 general practices participated in the final survey. The pre-study audit followed 63 discharges from the same ward.

Intervention

168 eligible patients were randomly assigned to have their electronic discharge summary sent by email (n = 40), fax (n = 48), post (n = 40) or patient hand delivery (n = 40).

Main outcome measures

Receipt of discharge summary by the general practice clinic within 7 days of patient discharge from hospital.

Results

The receipt rates for email (73.9%, n = 17) and fax were comparable (69.4%, n = 25; χ2 = 0.137, df = 1, P = 0.712), and significantly higher (χ2 = 19.86, df = 3, P < 0.0002) than post (43.8%, n = 14) and patient hand delivery (24.2%, n = 8). General practices indicated that fax was the most preferred method (82.7%) for communication of discharge summaries. The majority of general practices (75.0%) utilized an electronic system for storage of patient information while 88.5% of practices reported using medical prescribing software.

Conclusions

Transmission of computer-generated discharge summaries by fax or email offers the most effective method of communicating with primary care physicians, as long as accurate contact information is available. Although fax is still the most preferred, email has many advantages that could potentially allow it to replace fax as a standard mode for delivery of discharge communication.

Section snippets

Background

Timely and accurate discharge summaries play a critical role in the continuity of patient care between hospitals and primary care physicians or general practitioners (GPs) in the community. Ideally, hospital discharge summaries should communicate important medical information including presentation and diagnosis, investigation results, management changes, discharge medications and any further actions the GP is encouraged to pursue [1]. Poor discharge communication imposes a considerable burden

Setting

The study was undertaken within the acute aged care ward of a 350-bed metropolitan teaching hospital attached to the University of New South Wales in Sydney, Australia. Database based electronic discharge summaries are regularly generated by a multidisciplinary team, including doctors, nurses and allied health professionals, for all patients discharged from the ward. An electronic medication management system is also used to maintain medication charts for all patients. The electronic discharge

Audit and study period

Sixty-three discharge summaries were available for the pre-study audit over one month. In 14 cases GPs were not contactable. The receipt rate of the 49 discharge summaries that were available for follow-up was 55.1% (n = 27).

The study period included discharges of 196 patients admitted to the aged care ward over 10 weeks. Twenty-eight (28) patients were excluded because they were not admitted under a geriatrician (19) or were transferred to another ward prior to discharge (9). The remaining 168

Main findings and implications

We have compared four methods for delivering computer-generated hospital discharge summaries to general practice. While the accuracy of computer-generated discharge summaries has been previously investigated, few studies have examined the timeliness of specific methods for delivery of discharge communication. This is the first study we are aware of that compares the effectiveness of email, fax, post and patient hand delivery. We found that delivery via email and fax was comparable and

Conclusion

The method of discharge communication is an important factor in determining the timely delivery of a hospital discharge summary to general practice. Fax and email are the most effective modes for sending discharge summaries. Although fax is still widely accepted, email has the potential to overcome many of the shortcomings of fax and provide a secure and effective means of communication with GPs. Up-to-date GP contact details will likely improve rates of discharge summary receipt leading to

Acknowledgements

We thank the hospital and general practice staff who gave their time to participate in this study.

The source of funding for this study was from the University of New South Wales. YC is enrolled in a medical course within this institution and the study was undertaken as part of their degree.

FM is supported by the Australian Research Council (LP0775532) and the University of New South Wales, Faculty of Medicine.

Contributions: YC and NB were responsible for identifying the research question;

References (21)

  • T. Schabetsberger et al.

    From paper-based transmission of discharge summaries to electronic communication in health care regions

    Int. J. Med. Inform.

    (2006)
  • P.S. Woolman

    XML for electronic clinical communication in Scotland

    Int. J. Med. Inform.

    (2001)
  • S. Kripalani et al.

    Deficits in communication and information transfer between hospital-based and primary care physicians

    JAMA

    (2007)
  • E.M. Witherington et al.

    Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study

    Qual. Saf. Health Care

    (2008)
  • T.K. Gandhi et al.

    Communication breakdown in the outpatient referral process

    J. Gen. Intern. Med.

    (2000)
  • E.A. Coleman et al.

    Posthospital medication discrepancies: prevalence and contributing factors

    Arch. Intern. Med.

    (2005)
  • D. Bertrand et al.

    Quality assessment of discharge letters in a French university hospital

    Int. J. Health Care Qual. Assur. Inc. Leadersh. Health Serv.

    (1998)
  • M. Alderton et al.

    Are general practitioners satisfied with electronic discharge summaries?

    HIM J.

    (2007)
  • C. van Walraven et al.

    Dictated versus database-generated discharge summaries: a randomized clinical trial

    CMAJ

    (1999)
  • S. Middleton et al.

    Effective discharge policy: are we getting there?

    Aust. Health Rev.

    (2004)
There are more references available in the full text version of this article.
View full text