Discharge Summary Availability and Discontinuity Errors

医学研究所报告中的不良事件发生率可能低估了 美国病人安全问题的总体程度，由于受伤发生后，从 医院不包括在内。因急性疾病住院的病人往往在新的 药物，测试结果仍悬而未决，以及需要治疗的亚急性医疗问题， 已解决，但不值得进一步住院治疗。未能跟进这些未解决的医疗问题 由于诊断和治疗的延误，可能导致不良结果。出院小结 传统上是将这些信息从住院患者传达给 门诊医生然而，传达这些信息的系统往往不是最佳的， 超过一半的门诊初级保健医生（PCP）曾经收到他们的病人出院 摘要。中断错误（用药连续性错误、检查随访错误和检查错误） 由于住院病人与门诊病人之间关于病人出院计划的沟通不畅， 50%的时间。 这项研究的具体目标是： 1.对医院进行一项具有全国代表性的调查，以确定目前使用的系统， 沟通出院信息和他们的感知效果。 2.利用自然实验进行中断的时间序列队列研究， 并比较住院前后发生的不连续性错误的频率 推行网上系统，向门诊诊所医生发放出院摘要。 评估不连续性错误（用药连续性错误、测试随访错误和 检查错误）和不良事件（再入院、艾德就诊和紧急就诊）。 4.设计并评估一项随机对照试验，以比较电子邮件（主动）的有效性 传播电子出院的策略与基于网络的（被动）策略 降低不连续性错误和不良事件发生率的总结。

The incidence of adverse events in the Institute of Medicine's report To Erris Human may underestimate the overall extent of the patient safety problem in the U.S., since injuries occurring after discharge from the hospital were not included. Patients hospitalized for acute medical conditions are often discharged on new medications, with test results that are still pending, and with subacute medical problems that need to be addressed, but do not merit further hospitalization. Failure to follow-up on these unresolved medical issues may result in poor outcomes because of delays in diagnosis and treatment. The hospital discharge summary has traditionally been the means through which this information is communicated from the inpatient to the outpatient physician. However, the systems to communicate this information are often suboptimal and less than half of all outpatient primary care physicians (PCPs) ever receive their patients' hospital discharge summaries. Discontinuity errors (medication continuity errors, test follow-up errors, and work-up errors) resulting from poor inpatient-to-outpatient communication about patients' discharge plans may occur as often as 50% of the time. The specific aims of the study are to: 1. Conduct a nationally representative survey of hospitals to identify the current systems used to communicate hospital discharge information and their perceived efficacy. 2. Take advantage of a natural experiment to perform an interrupted time series cohort study to measure and compare the frequency of discontinuity errors that occur after hospitalization before and after implementation of a web-based system to disseminate discharge summaries to outpatient PCPs. , Assess associations between discontinuity errors (medication continuity errors, test follow-up errors, and work-up errors) and adverse events (readmissions, ED visits, and urgent visits) in this cohort. 4. Design and evaluate a randomized-controlled trial to compare the effectiveness of an email (active) strategy versus a web-based (passive) strategy of disseminating electronic hospital discharge summaries for reducing rates of discontinuity errors and adverse events.