Improving Quality, Efficiency, and Patient/provider Satisfaction with Electronic Medication Reconciliation and Discharge Instructions

1Duke University, Durham, NC

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 186


Effective transitions of care are essential to improving health care delivery and include high‐quality medication reconciliation and discharge instructions. These are an important focus of the Joint Commission and of the meaningful use of health information technology under ARRA and will be key to the success of overall health care reform.


Risk of medication errors is particularly high during transitions of care as complex medication lists are reconciled at admission, transfer, and discharge. Harm can result from errors of omission, duplication, and illegibility. To improve our process, an electronic medication reconciliation pathway has been successfully implemented at Durham Regional Hospital (DRH). The provider is required to electronically reconcile all current orders and medications at transitions of care.


Through a detailed work‐flow analysis and software customization, a multidisciplinary steering committee implemented processes to meet the needs of patients, families, and staff. In the initial phase, DRH implemented electronic transfer and discharge medication reconciliation, as well as electronic discharge instruction on a pilot unit. We measured compliance with electronic processes, patient satisfaction with the overall discharge process (Press Ganey Survey), and staff satisfaction with the new electronic process (internal survey).


Compliance with the transfer medication reconciliation was expanded hospital‐wide and now has consistently been more than 90%. Compliance with discharge electronic medication reconciliation and discharge instructions on the pilot unit is also 100%. An internal survey showed high levels of satisfaction among the clinical staff with the electronic process, including improvements in work flow, efficiency, and perception of safety. Patient satisfaction in the pilot unit changed from the 10th percentile to the 99th per‐centile for discharge instructions, reflecting a very significant improvement in patient satisfaction with the discharge process. The result is a clearer and more accurate set of discharge medications and detailed instructions for posthospitalization care. In addition to being legible, these instructions have led to improved patient, family, and provider satisfaction. Because of our initial success with the rehabilitation unit, we are now piloting hospital‐wide implementation of all components of electronic medication reconciliation, including admission and discharge medical reconciliation, as well as comprehensive discharge instructions—beginning with surgery, followed by medicine, psychiatry, and obstetrics. We also expect to demonstrate increased compliance with these required steps and benefits in patient safety, including a decreased rate of readmissions. We will continue to measure patient and staff satisfaction and are currently conducting a time study to determine whether the electronic process can objectively improve efficiency in work flow.

Provider satisfaction.

Press Satisfaction


J. Lovins ‐ Duke University, speaker for Cubist Pharmaceuticals (no conflict of interest); R. Beavers ‐ none; R. Lineberger ‐ none

To cite this abstract:

Lovins J, Beavers R, Lineberger R. Improving Quality, Efficiency, and Patient/provider Satisfaction with Electronic Medication Reconciliation and Discharge Instructions. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 186. Journal of Hospital Medicine. 2011; 6 (suppl 2). Accessed March 28, 2020.

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