A systematic review of discharge arrangements for older people

Abstract

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Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

“…Data regarding the effectiveness of pre-and postdischarge interventions have been mixed, but targeting these lower acuity admissions may be more cost-effective than interventions addressing long-term outpatient disease management. [38][39][40][41][42][43][44][45] Primary care access and ED utilization patterns have been examined in multiple studies looking at risk for admission, with varying results. 4,6,12,13,[46][47][48] In our study, self-reported ambulatory care did not differ between the patients with strongly acuity-driven and moderately/weakly acuity-driven admissions.…”

Preventing the rebound: improving care transition in hospital discharge processes

“…61 In a recent metareview, Mistiaen and colleagues 24 retrieved systematic reviews published between 1994 and 2004 that assessed effectiveness of peridischarge interventions aimed at reducing postdischarge problems in adults discharged home from acute general hospital care. Of 15 reviews selected, only three showed reductions in readmissions and all three 22,54,62 were characterised by the combination of patient education and preand postdischarge support.…”

“…26 These include the Hospital Admission Risk Profile, Identification of Seniors at Risk, and Care Complexity Prediction Instrument. In three reviews, 22,23,27 systematic use of these instruments exerted no significant effects on readmission rates.…”

“…Two reviews 22,23 assessed educational interventions and found no effect on readmissions. A randomised trial involving 750 elderly patients compared transition coaching and self-management tuition in medication use, personal health record, timely follow-up with GPs and specialists, and knowledge of complications and how to respond, with usual care.…”

In response – additional support to high-risk patients can reduce hospital readmissions

“…2,3 We read with interest Woodard and Conroy's description of an acute frailty unit, which will likely improve the standard of care provided to older patients, and we await with further data from their experience.…”