Discharge planning curricula in internal medicine residency programs: a national survey.

BACKGROUND: Transition of patient care from an inpatient to outpatient setting is a critical aspect of patient care. The objectives of this study were to describe the content and evaluation of the discharge planning curricula (DPC) in internal medicine (IM) residency programs and identify program directors' perceptions of discharge planning education. METHOD: A 24-item questionnaire was sent to 387 IM program directors during April 2005. The analysis was conducted using SPSS (version 15). RESULTS: A total of 140 program directors (PDs) responded. Formal DPC was offered in 16% (n = 23) of the programs. Hospital resources to coordinate transition of care and communication skills were the main curricular content areas. Seventy-five percent of the PDs agreed that discharge planning should be an important part of the curriculum. More than 50% of the PDs agreed that discharge planning would decrease the re-admission rate, and increase patient satisfaction and referring physician satisfaction. The programs with a DPC had a higher level of agreement that a DPC program would facilitate continuity of care between inpatient and outpatient care (P = 0.027) compared to programs without a DPC. CONCLUSIONS: The majority of the PDs agreed that DPC should be an important curricular component, yet only a few programs offered formal discharge planning education. Residency programs need to address this critical aspect of patient care within the core curricula.

Patient readmissions, emergency visits, and adverse events after software-assisted discharge from hospital: cluster randomized trial.

BACKGROUND: One of the causes of postdischarge adverse events is poor discharge communication between hospital-based physicians, patients, and outpatient physicians. The value of hospital discharge software to improve communication and clinically relevant outcomes is unknown. OBJECTIVE: To measure effects of a discharge software application of computerized physician order entry (CPOE). DESIGN: Cluster randomized controlled trial. SETTING: Tertiary care, teaching hospital in central Illinois. PATIENTS: A total of 631 inpatients discharged to home with high risk for readmission. INTERVENTION: Seventy internal medicine hospital physicians were randomly assigned (allocation concealed) to discharge software versus usual care, handwritten discharge. MEASUREMENTS: Blinded assessment of patient readmission, emergency department visit, and postdischarge adverse event. RESULTS: A total of 590 (94%) patients provided 6-month follow-up data. Generalized estimating equations gave intervention variable coefficients with 95% confidence interval (CI). When comparing patients assigned to discharge software versus usual care, there was no difference in hospital readmission within 6 months (37.0% versus 37.8%; coefficient -0.005 [95% CI, -0.074 to 0.065]; P = 0.894), emergency department visit within 6 months (35.4% versus 40.6%; coefficient -0.052 [95% CI, -0.115 to 0.011]; P = 0.108), or adverse event within 1 month (7.3% versus 7.3%; coefficient 0.003 [95% CI; -0.037 to 0.043]; P = 0.884). CONCLUSIONS: Discharge software with CPOE did not affect readmissions, emergency department visits, or adverse events after discharge. Future studies should assess other endpoints such as patient perceptions or physician perceptions to see if discharge software has value.