Objective: 

Effective communication between clinicians is essential for seamless discharge of patients between care settings. Yet, discharge summaries are commonly not available and incomplete. We implemented and evaluated a structured electronic health record–embedded electronic discharge (eDischarge) summary tool for patients discharged from the ICU to a hospital ward.

DESIGN: 

Multiple baseline trial with randomized and staggered implementation.

SETTING: 

Adult medical-surgical ICUs at four acute care hospitals serving a single Canadian city.

PATIENTS: 

Health records of patients 18 years old or older, in the ICU 24 hours or longer, and discharged from the ICU to an in-hospital patient ward between February 12, 2018, and June 30, 2019.

INTERVENTION: 

A structured electronic note (ICU eDischarge tool) with predefined fields (e.g., diagnosis) embedded in the hospital-wide electronic health information system.

MEASUREMENTS AND MAIN RESULTS: 

We compared the percent of timely (available at discharge) and complete (included goals of care designation, diagnosis, list of active issues, active medications) discharge summaries pre and post implementation using mixed effects logistic regression models. After implementing the ICU eDischarge tool, there was an immediate and sustained increase in the proportion of patients discharged from ICU with timely and complete discharge summaries from 10.8% (preimplementation period) to 71.1% (postimplementation period) (adjusted odds ratio, 32.43; 95% CI, 18.22–57.73). No significant changes were observed in rapid response activation, cardiopulmonary arrest, death in hospital, ICU readmission, and hospital length of stay following ICU discharge. Preventable (60.1 vs 5.7 per 1,000 d; p = 0.023), but not nonpreventable (27.3 vs 40.2 per 1,000d; p = 0.54), adverse events decreased post implementation. Clinicians perceived the eDischarge tool to produce a higher quality discharge process.

CONCLUSIONS: 

Implementation of an electronic tool was associated with more timely and complete discharge summaries for patients discharged from the ICU to a hospital ward.

中文翻译：

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用于提高护理质量的电子 ICU 出院总结工具的多基线试验*

客观的： 

临床医生之间的有效沟通对于患者在不同护理环境之间的无缝出院至关重要。然而，出院摘要通常不可用且不完整。我们为从 ICU 出院到医院病房的患者实施并评估了一个结构化的电子健康记录——嵌入式电子出院 (eDischarge) 摘要工具。

设计： 

随机和交错实施的多基线试验。

环境： 

服务于加拿大一个城市的四家急症医院的成人医疗外科 ICU。

患者： 

2018年2月12日至2019年6月30日期间在ICU 24小时或更长时间从ICU出院到住院病房的18岁或以上患者的健康记录。

干涉： 

具有预定义字段（例如，诊断）的结构化电子笔记（ICU eDischarge 工具）嵌入在医院范围的电子健康信息系统中。

测量和主要结果： 

我们使用混合效应逻辑回归模型比较了实施前后及时（出院时可用）和完整（包括护理指定目标、诊断、活跃问题列表、活跃药物）出院总结的百分比。实施 ICU eDischarge 工具后，从 ICU 出院并及时完成出院总结的患者比例立即持续增加，从 10.8%（实施前）增加到 71.1%（实施后）（调整后的比值比，32.43；95 % 置信区间，18.22–57.73）。在快速反应激活、心肺骤停、住院死亡、ICU 再入院和 ICU 出院后住院时间方面未观察到显着变化。可预防（每 1,000 天 60.1 对 5.7；p= 0.023），但并非不可预防（每 1,000 天 27.3 对 40.2；p = 0.54），不良事件在实施后减少。临床医生认为 eDischarge 工具可以产生更高质量的放电过程。

结论： 

电子工具的实施与从 ICU 出院到医院病房的患者更及时、更完整的出院总结相关。