Compliance with emergency department referral: the effect of computerized discharge instructions

Ann Emerg Med. 1993 May;22(5):819-23. doi: 10.1016/s0196-0644(05)80798-x.


Study objective: To examine the effect of computerized discharge instructions on emergency department patient referral recommendations.

Design: Prospective, descriptive analysis and clinical trial.

Setting: Emergency medicine residency-affiliated urban hospital with 568 beds and 29,000 annual visits.

Type of participants: One thousand ED patients discharged to an outpatient referral network during a six-week period.

Intervention: Mandatory referral was provided in written or computerized (Logicare Corp, Eau Claire, Wisconsin) format for each 500-patient group. Demographic data and compliance, measured as appointment completion within 30 days, were analyzed using chi 2 with Yates' correction, Fisher's exact, and odds ratio comparisons (P < .05, 95% confidence interval).

Measurements and main results: The institution of computerized discharge instructions resulted in increased overall patient compliance from 26.2% to 36.2% (P < .0008) with odds ratio of 1.59 (1.2 to 2.1). Subset analysis showed increased compliance in patients who were more than 40 years old (32.5% to 61.1%), were female (28.7% to 39.7%) with a private physician (36.4% to 53.9%), established hospital relationship (26.1% to 38.9%), had nonurgent complaints (26.5% to 36.2%), were specifically diagnosed with strain or contusion (17.0% to 36.8%), or were referred to obstetrics/gynecology clinic (13.2% to 48.6%) (P < .001).

Conclusion: Computerized discharge instructions were associated with improved compliance with ED referral recommendations, based on historic and contemporary controls.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Hospital Bed Capacity, 500 and over
  • Hospital Information Systems
  • Hospitals, Urban
  • Humans
  • Infant
  • Male
  • Medical Records Systems, Computerized*
  • Middle Aged
  • Patient Compliance*
  • Patient Discharge*
  • Pennsylvania
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data