Compliance with emergency department referral: the effect of computerized discharge instructions.

Abstract

To examine the effect of computerized discharge instructions on emergency department patient referral recommendations. Prospective, descriptive analysis and clinical trial. Emergency medicine residency-affiliated urban hospital with 568 beds and 29,000 annual visits. One thousand ED patients discharged to an outpatient referral network during a six-week period. Mandatory referral was provided in written or computerized (Logicare Corp, Eau Claire, Wisconsin) format for each 500-patient group. Demographic data and compliance, measured as appointment completion within 30 days, were analyzed using chi 2 with Yates' correction, Fisher's exact, and odds ratio comparisons (P < .05, 95% confidence interval). The institution of computerized discharge instructions resulted in increased overall patient compliance 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 relationship (26.1% to 38.9%), had nonurgent complaints (26.5% to 36.2%), were specifically diagnosed with strain or contusion (17.0% to 36.8%), or were referred to obstetrics/gynecology clinic (13.2% to 48.6%) (P < .001). Computerized discharge instructions were associated with improved compliance with ED referral recommendations, based on historic and contemporary controls.