COMPLIANCE WITH EMERGENCY DEPARTMENT REFERRAL - THE EFFECT OF COMPUTERIZED DISCHARGE INSTRUCTIONS

Study objective: To examine the effect of computerized discharge instr uctions on emergency department patient referral recommendations. Desi gn: Prospective, descriptive analysis and clinical trial. Setting: Eme rgency medicine residency-affiliated urban hospital with 568 beds and 29,000 annual visits. Type of participants: One thousand ED patients d ischarged to an outpatient referral network during a six-week period. Intervention: Mandatory referral was provided in written or computeriz ed (Logicare Corp, Eau Claire, Wisconsin) format for each 500-patient group. Demographic data and compliance, measured as appointment comple tion within 30 days, were analyzed using chi2 with Yates' correction, Fisher's exact, and odds ratio comparisons (P<.05, 95% confidence inte rval). Measurements and main results: The institution of computerized discharge instructions resulted in increased overall patient complianc e from 26.2% to 36.2% (P<.0008) with odds ratio of 1.59 (1.2 to 2.1). Subset analysis showed increased compliance in patients who were more than 40 years old (32.5% to 61.1%), were female (28.7% to 39.7%) with a private physician (36.4% to 53.9%), established hospital relationshi p (26.1% to 38.9%), had nonurgent complaints (26.5% to 36.2%), were sp ecifically diagnosed with strain or contusion (17.0% to 36.8%), or wer e referred to obstetrics/gynecology clinic (13.2% to 48.6%) (P<.001). Conclusion: Computerized discharge instructions were associated with i mproved compliance with ED referral recommendations, based on historic and contemporary controls.