Health interventions for the reduction of hospital readmission within 30 days in clinical patients: An integrative review

Abstract

Study with the objective of analysing the evidence available in the scientific literature on the interventions used to reduce hospital readmissions within 30 days in clinical patients who were discharged from the hospital to the home. An integrative review was carried out on the online Medical Literature Analysis and Retrieval System and Latin American and Caribbean Literature in Health Sciences databases. Intervention research, published between January 2009 and April 2020, in Portuguese, English and Spanish, was included. The sample consisted of 71 articles. The most frequently performed interventions were telephone contact after discharge (73.2%), health education after discharge (71.8%) and health education during hospitalization (67.6%). Identification of readmission risk (12.9%), home visits after discharge (26.8%) and discharge planning (28.2%) were the least mentioned. The interventions were performed predominantly by a multidisciplinary team (39.5%). There was a significant reduction in readmissions in 50.7% of the studies. It was found that the interventions are aimed at preparing the patient during hospitalization for the return home and post-discharge monitoring to reinforce the care plans and clarify doubts, this important combination of different actions by the multiprofessional team impacts readmission rates.

Development of a measurement instrument to assess patient safe transition at hospital discharge

“…These include such items as the identification of readmission risk, the development of a discharge plan in advance, and considering the patients' and/or caregivers' values and preferences. These items are all corroborated by the literature (7,17) .…”

“…The "Care education" domain addresses the perception about health education activities to prepare the patient and caregiver for hospital discharge, including aspects related to care after discharge, such as personal hygiene, diet, therapeutic devices, medication use and warning signs, among others described in the literature (9)(10) . In addition, the domain addresses some health education strategies that contribute to transitional care, such as clarifying questions and using educational materials (17) .…”

“…The "Referral for continuity of care" domain deals with activities to ensure access to health services for care continuity after discharge including referral to primary care, services that provide necessary materials to the patient, and follow-up after discharge (17) .…”

“…The final sample consisted of 71 articles. This integrative review that sustained Stage 1 is published elsewhere (17) .…”

“…The following components were listed in the integrative review: identification of readmission risk, discharge planning, health education at hospital admission, health education after discharge, medication reconciliation, communication with the health services, outpatient follow-up after discharge, telephone contact after discharge, and home visit after discharge (17) . Analysis of the interviews resulted in three thematic categories supported by 10 subcategories (Chart 1).…”