Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial

Eddy Lang ^1*, Marc Afilalo ¹, Alain C. Vandal ², Jean-Franois Boivin ³, Xiaoqing Xue ¹, Antoinette Colacone ¹, Ruth Léger ¹, Ian Shrier ⁴, Stephen Rosenthal ¹

¹ Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis-Jewish General Hospital
² Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis-Jewish General Hospital and the Department of Mathematics and Statistics, McGill University, Montréal, Qué.
³ Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis-Jewish General Hospital and the Department Epidemiology and Biostatistics, McGill University, Montréal, Qué.
⁴ Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis-Jewish General Hospital

^* To whom correspondence should be addressed. E-mail: eddy.lang{at}mcgill.ca.

	Abstract

Background: Electronic information exchange is believed to improve efficiency and reduce resource utilization. We developed a Web-based standardized communication system (SCS) that enables family physicians to receive detailed reports of their patients' care in the emergency department. We sought to determine the impact of the SCS on measures of resource utilization in the emergency department and family physician offices.

Methods: We used an open 4-period crossover clusterrandomized controlled design. During 2 separate 10-week intervention phases, family physicians received detailed reports of their patients' emergency department visits over the Internet, and in the alternating control phases they received a 1-page copy of the emergency department notes by mail. The primary outcome was the number of repeat visits to the emergency department within 14 days of the initial visit. Secondary outcomes included duplication of test and specialty consultation requests by the emergency and family physician. Outcomes were measured using the hospital database and questionnaires sent to the family physicians.

Results: A total of 2022 patient visits to the emergency department from 23 practices were used in the study. Use of the SCS failed to reduce the number of repeat visits to the emergency department within 14 days (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.8-1.51) and 28 days (OR 1.01, 95% CI 0.8-1.27). There was no significant duplication of requests for diagnostic tests between the emergency and family physician during the intervention and control phases (24 v. 22, p= 0.93), but there was significantly greater duplication in specialty consultation requests in the intervention phase than in the control phase (20 v. 8, p= 0.049).

Interpretation: An electronic link between emergency and family physicians did not result in a significant reduction in resource utilization at either service point. Investments in improved electronic information exchange between emergency departments and family physician offices may not be substantiated by a reduction in resource utilization.