Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis

Abstract

Background The transition from acute mental health inpatient care to community care is often a vulnerable period in the pathway, where people can experience additional risks and anxiety. Researchers globally have developed and tested a number of interventions that aim to improve continuity of care and safety in the transitions. However, there has been little attempt to compare and contrast the interventions and specify the variety of safety threats they attempt to resolve.Methods The study aimed to identify the evidence base for interventions to support continuity of care and safety in the transition from acute mental health inpatient service to community care services at the point of discharge. Electronic Databases including PsycINFO, MEDLINE, Embase, HMIC, CINAHL, IBSS, Cochrane Library Trials, ASSIA, Web of Science and Scopus, were searched between 2000 and May 2018. Peer reviewed papers were eligible for inclusion if they addressed adults admitted to an acute inpatient mental health ward and reported on health interventions surrounding discharge from the acute ward to the community. The results were analysed using a narrative synthesis technique.Results The total number of papers from which data was extracted was 45. The review found various interventions implemented across continents, addressing problems related to different aspects of discharge. Some interventions followed a distinct named approach (i.e. Critical Time Intervention, Transitional Discharge Model) others were grouped based on key components (i.e. peer support, pharmacist involvement). The primary problems interventions looked to address were reducing readmission, improving wellbeing, reducing homelessness, improving treatment adherence, accelerating discharge, reducing suicide. The 69 outcomes reported across studies were heterogeneous, meaning it was difficult to conduct comparative quantitative meta-analysis or synthesis.Conclusions The interventions reviewed are spread across a spectrum ranging from addressing a single problem within a single agency with a single solution, to multiple solutions addressing multi-agency problems. We recommend that future research attempts to improve homogeneity in outcome reporting.

Are Patients Improving during and after a Psychiatric Hospitalisation? Continuity of Care Outcomes of Compulsory and Voluntary Admissions to an Italian Psychiatric Ward

“…Moreover, international studies have been mainly concentrated on the effects of specific transitional interventions after discharge from inpatient psychiatric facilities 21,22 , but we did not find evidences on patients' outcomes after a follow-up period, in a mental health setting based on longitudinal continuity of care. In a previous study from the region 23 , we observed that both CA and VA patients improved during hospitalisation.…”

Goals of care or goals of life? A qualitative study of clinicians’ and patients’ experiences of hospital discharge using Patient-Oriented Discharge Summaries (PODS)

“…Prior research on transition planning interventions among psychiatric patient populations suggests that discharge planning is key to preventing readmission [8]. Existing literature cites collaborative care between inpatient staff, psychoeducation for patients and caregivers, communication between inpatient and outpatient networks, and medication reconciliation as important pieces of effective discharge and transition planning interventions [15][16][17]. Therefore, the PODS tool for medical discharge was modified at the Centre for Addiction and Mental Health (CAMH), a tertiary care psychiatric hospital in Ontario, Canada, to suit the informational needs of individuals transitioning from psychiatric hospital to the community.…”

What does safety in mental healthcare transitions mean for service users and other stakeholder groups: An open‐ended questionnaire study

“…International researchers were invited to participate whether they had published a peer‐reviewed paper in a previous systematic review, 50 researchers were invited 15 . Twenty‐nine British end users of research were identified using publicly accessible contact details and individually invited to participate.…”

“…Multiple systems‐level risk factors for safety have been found in mental health‐care transitions, namely the lack of continuity of care, co‐ordination and communication difficulties between organizations and professionals 6‐9 . Various interventions have been developed to improve safety in mental health services 10‐14 but very few explicitly describe an underlying theory of change 15 . Yet it is increasingly recognized that the evaluation of quality improvement interventions, such as those for hospital discharge, should more overtly articulate and appraise the underpinning theory of change for a given intervention (the rationale and assumptions about mechanisms that links processes and inputs to outcomes, also specifying the conditions necessary for effectiveness) 16,17 .…”