Effect of a formalised discharge process which includes electronic delivery of prescriptions to pharmacies on the incidence of delayed prescription retrieval.

BACKGROUND: Lack of prescription adherence after discharge from the inpatient hospital setting is a barrier to the delivery of optimal patient care. Non-adherence to medication for cardiac diseases can lead to substantial morbidity, mortality and healthcare costs. Electronic delivery of prescriptions by fax is a potential method of improving patient satisfaction and reducing pharmacy wait times. METHODS: This study was completed in the cardiology inpatient wards at a hospital in London, Ontario, Canada. 'Delayed prescription retrieval' was defined as the retrieval of a prescribed medication by a patient from their local pharmacy after the documented calendar day of discharge. The current discharge process on the cardiology wards was assessed and an initial monitoring period of study participants was completed to determine the baseline delayed prescription retrieval rate (preintervention group). A formalised discharge process, which included electronic delivery of prescriptions to pharmacies by fax, was implemented for study participants (postintervention group). The rate of delayed prescription retrieval was assessed in both groups. RESULTS: 15 of 42 patients (35.7%) in the preintervention group and 9 of 72 (14.3%) in the postintervention group had delayed prescription retrieval suggesting relative and absolute risk reductions of 65% and 23.2% (p=0.0045). Of the participants with delayed prescription retrieval, 100% in the preintervention group and 77.8% in the postintervention group were due a new prescribed medication on the day of discharge. CONCLUSIONS: Patients who experienced a formalised discharge process, which included electronic delivery of prescriptions by fax, at the time of discharge from cardiac inpatient care had a lower rate of delayed prescription retrieval. Future studies are required to examine the impact of formal discharge processes on patient morbidity and mortality.

Clinical presentation and outcome of patients with ST-segment elevation myocardial infarction without culprit angiographic lesions.

Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) are occasionally found to have no culprit lesion on coronary angiography and are classified as presenting with false-positive STEMI. The clinical presentation and outcomes of these patients need to be further explored. In this case-controlled study, 259 consecutive patients with true code STEMI were compared to 104 consecutive STEMI patients without culprit lesions on emergent coronary angiography. We compared the clinical presentation, electrocardiographic features, etiology, and outcomes of the two groups. STEMI patients without culprit lesions were less likely to have typical chest pain (46% vs. 79%, P < 0.01). The ST-elevation in the group without culprit lesion was more likely to be concave (56% vs. 31%, P < 0.01), with less reciprocal ST-depression (19% vs. 71%, P < 0.01). The group without culprit lesions had a higher rate of ventilator support requirement (12.4% vs. 5.4%, P = 0.02), and higher rate of 30-day mortality (11.0% vs. 5.9%, P = 0.02). However, after excluding the patients with out-of-hospital cardiac arrests from both groups, the difference was no longer significant (P = 0.40 and 0.34 respectively). The relative poor outcomes of patients with false-positive code STEMI reflect the severity of their underlying medical condition. Careful history and review of ECG may help differentiate this group from true STEMI.