Discharge Summary Availability and Discontinuity Errors

医学研究所提交给Erris Human的报告中的不良事件发生率可能低估了 美国患者安全问题的总体程度，因为在出院后发生伤害 医院不包括在内。因急性疾病住院的患者通常在新的 药物，测试结果仍在等待，亚急性医疗问题需要 已得到解决，但不值得进一步住院。未能跟进这些悬而未决的医疗问题 可能会因为延误诊断和治疗而导致不良结果。出院汇总表 传统上是将这一信息从住院患者传达给 门诊部医生。然而，传达这种信息的系统往往不是最优的，而且不太理想 超过一半的门诊初级保健医生(PCP)曾接受过患者的出院治疗 摘要。不连续性错误(药物连续性错误、测试跟踪错误和工作错误) 由于住院患者与门诊患者之间关于患者出院计划的沟通不畅而导致的情况可能会经常发生 在50%的情况下。 这项研究的具体目的是： 1.对具有全国代表性的医院进行调查，以确定目前用于 传达医院出院信息及其感受到的疗效。 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不连续错误的频率 实施基于网络的系统，向门诊初级保健医生发布出院摘要。 ，评估间断错误(用药连续性错误、测试跟踪错误和 检查错误)和不良事件(再次入院、急诊室就诊和紧急就诊)。 4.设计并评估一项随机对照试验，以比较电子邮件的有效性(主动) 传播电子医院出院的策略与基于网络的(被动)策略 减少不连续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.