a prospective case control study of the benefits of e-discharge summaries
George Thomson and Eddie Olla
Consultant Physician /NCR Programme Manager & Business Development Manager,
Sherwood Forest Hospitals NHS Trust
Tel: 01623 622515 ext: 6185/3393
Email: George.Thomson@sfh-tr.nhs.uk; Eddie.Olla@sfh-tr.nhs.uk
Summary:
The aim of the initiative was to develop a failsafe clinical management system to integrate e-discharge prescriptions with e-discharge summaries Sherwood Forest Hospitals Trust conducted a prospective case-control study of 102 consecutive patients admitted to our hospital under the care of one consultant physician. Patients (50) were discharged from the pilot using the new e-system whereas a conventional paper system was used for patients (52) admitted to an outlier ward. In conclusion, the study found that by combining e-discharge prescriptions with e-summaries offered significant potential for improvements in clinical governance and gains in efficiency for medical and secretarial staff.
Abstract:
A multidisciplinary group of medical, pharmacy and IT staff developed a clinical system aimed to provide GP’s with accurate, comprehensive and timely discharge summaries within a two-week period as recommended by the DOH. The service also looked at the clinical governance gains with the avoidance of prescribing errors (dose, legibility). The cost effectiveness of the service was highlighted with reduced stages in the discharge process and the secretarial time required typing the summaries.
The TTO (To Take Out) Project Board worked closely with a clinical champion and key clinicians involved in the pilot. A multidisciplinary core of service users was consulted to incorporate views and assist in the development process of the e-Discharge project. A change manager was allocated to support the new “ways of working” and drive out maximum benefits from the design of the system.
The Project Board have met on a regular basis to discuss any issues or risks identified and then further development work has taken place to address these. The project has been an organic process with users helping to shape the project during the pilot phase.
The pilot highlighted that secretarial support was less intensive allowing for improved time utilisation. The service users have developed their IT skills during the implementation of the project. The pilot has demonstrated that it can relieve the demand for staff roles such as secretaries and the impact for the Trust will be explored in a separate study.A prospective case control study was undertaken with 50 patients discharged from the pilot using the new e-system and 52 patients discharged using the conventional paper system. Subjects were similar for age [67(48-77) vs 58(40-77) years, P=NS] and hospital stay [6(3-11) vs 1(1-5) days, P=NS] in e-discharge and conventional groups respectively. Time taken to produce an e-summary was significantly reduced (P<0.0001); [0(0-0) vs 80(55-106) days]. Medical time per summary was [14.5(10-23) vs 6(4-11) minutes)] respectively and was significantly longer (p<0.000001) for e-summaries. Conversely required secretarial time [0(0-0) vs 5(3-6) minutes respectively] was significantly reduced (p< 1 x 10-17).
The e-system enabled immediate discharge summaries eliminating delay in sending them to general practitioners and also highlighted a saving in secretarial time.
Patients discharged using the e-Discharge system leave the hospital with a legible copy of the discharge summary, which benefits them considerably with the possibility of revolving door admissions. When the patient is admitted, the new process ensures that the discharge is timely leading to fewer delays for the patient. The patient can be assured when they visit their doctor for a repeat prescription that he has received the discharge summary from the doctor informing him of the patients’ discharge medication.
The new e-system is used by multidisciplinary service users. It begins with the doctor who completes the patient history, allergies, treatment and medication details. Then the pharmacist who checks the medication, the technician who checks the dose and frequency and last but not least nurses who complete the discharge arrangements and print the e-discharge letter. All these groups were consulted in the development process of the new system and new “ways of working”.
A paper on the e-Discharge summary pilot and case study was recently published by the Royal Federation of Internal Medicine.
Dr George Thomson was recently invited to The Royal Society of Medicine to give a presentation on the successful pilot of e-Discharges and the study that has been conducted.
The pilot is due to be rolled-out to other wards within Sherwood Forest Hospitals Trust in 2006.
This pilot is an enabler for Sherwood Forest Hospitals Trust to understand how to improve the planning and predicting discharges process. This will lead to improved bed management and a better experience for the patient. The Trust would like to ensure that we are able to provide GPs with a discharge summary on the day of discharge whenever possible and exploit the potential for improvements in clinical governance. The initial findings of this pilot demonstrate conclusively that this is an achievable goal.
