Discharge planning from hospital

Abstract

BackgroundDischarge planning is a routine feature of health systems in many countries that aims to reduce delayed discharge from hospital, and improve the co-ordination of services following discharge from hospital and reduce the risk of hospital readmission. This is the fi h update of the original review. ObjectivesTo assess the e ectiveness of planning the discharge of individual patients moving from hospital. Search methodsWe searched CENTRAL, MEDLINE, Embase and two trials registers on 20 April 2021. We searched two other databases up to 31 March 2020. We also conducted reference checking, citation searching and contact with study authors to identify additional studies. Selection criteriaRandomised trials that compared an individualised discharge plan with routine discharge that was not tailored to individual participants. Participants were hospital inpatients. Data collection and analysisTwo review authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies by older people with a medical condition, people recovering from surgery, and studies that recruited participants with a mix of conditions. We calculated risk ratios (RRs) for dichotomous outcomes and mean di erences (MDs) for continuous data using fixed-e ect meta-analysis. When combining outcome data it was not possible because of di erences in the reporting of outcomes, we summarised the reported results for each trial in the text. Main resultsWe included 33 trials (12,242 participants), four new trials included in this update. The majority of trials (N = 30) recruited participants with a medical diagnosis, average age range 60 to 84 years; four of these trials also recruited participants who were in hospital for a surgical procedure. Participants allocated to discharge planning and who were in hospital for a medical condition had a small reduction in the initial hospital length of stay (MD − 0.73, 95% confidence interval (CI) − 1.33 to − 0.12; 11 trials, 2113 participants; moderate-certainty evidence), and a relative reduction in readmission to hospital over an average of three months follow-up (RR 0.89, 95% CI 0.81 to 0.97; 17 Discharge planning from hospital (Review)

Informal carers' support needs, facilitators and barriers in the transitional care of older adults: A qualitative study

“…5 Interview findings with carers were characterized by carer stress In previous studies emphasizing health services' efficiencies in transitional care research, the focus was on the management of inpatient bed demand. 8 Previous research in transitional care has largely defined effective transitional care in institutional terms, for example, where transitional care is defined as discharge planning and preparation. 8 The institutional focus in transitional care research is particularly notable in health services' outcomes and measures of efficiency such as readmission rates and length of stay.…”

“…Currently, transitional care research emphasizes outcomes for health services such as early readmission rates and length of stay. 8 , 9 In these studies, 8 , 9 researchers identified that compared with usual care, formal transitional care interventions including discharge assessment, planning, care coordination, medication reconciliation and self‐management reduce length of stay and readmission rates. Two well‐researched models used in the United States of America, the Care Transitions Intervention 3 and the Transitional Care Model, 10 have been influential in orienting health services towards the importance of self‐management and advanced practice nursing support.…”

A rapid review of what innovative workforce models have helped to rapidly grow capacity for community care to help older adults leave hospital

“…The quality of the systematic reviews was assessed using the AMSTAR 2 quality appraisal tool. According to AMSTAR 2, quality of 3 of the systematic reviews (Gonçalves-Bradley et al 2022; Handoll et al 2021; Tomlinson et al 2020) were rated as moderate; one was rated as low (Rasmussen et al 2021) and 7 as critically low (Facchinetti et al 2020; Gonçalves-Bradley et al 2017; Langhorne et al 2017; Lee et al 2022; Mabire et al 2016; Meulenbroeks et al 2021 Williams et al 2022). The primary studies were appraised using the appropriate quality appraisal form (see Section 5.8).…”

“…Gonçalves-Bradley et al (2022) performed a systematic review of RCTs to assess the effectiveness of an individualised discharge plan for patients moving from hospital as compared to routine discharge. Searches were completed in April 2021.…”

“…Four of the systematic reviews were Cochrane reviews (Gonçalves-Bradley et al 2017, 2022; Handoll et al 2021 Langhorne et al 2017), the other 7 systematic reviews and 5 of the primary studies were published as journal articles. Home Based Bridging Care Project Evaluation (2022), Jones et al (2022) and National Team for Inclusion (2019) were ‘grey literature’ i.e., reports published outside of traditional commercial publishing 1 .…”