Effectiveness of discharge interventions from hospital to home to reduce readmissions: a systematic review.

Abstract

Review objective / question The objective of this review is to identify discharge interventions from hospital to home that have been demonstrated to be effective in reducing readmissions within three months in medical/surgical adult patients and to understand their effect on secondary outcome measures. The specific review questions are a. Which discharge interventions can reduce readmissions within three months after discharge from the hospital? b. In addition to reducing readmissions, what is the effect of these discharge interventions on: i. Length of stay; ii. Mortality; iii. Use of emergency department; iv. Patient satisfaction? Inclusion criteria Types of participants This review will consider studies that include adult patients discharged from a medical or surgical ward of an acute hospital. We will include studies with participants aged 18 years or older, male and female. Discharges from an emergency department or intensive care unit and patients receiving palliative care, psychiatric care or obstetrical stays will be excluded from this review. Types of interventions This review will consider studies that evaluated the effectiveness of discharge interventions in reducing readmissions. The included interventions had to start in the hospital and must be performed – at least partly – by hospital professionals with the intention of smoothing the care transition out of the hospital towards home or to prevent or diminish problems after hospital discharge. Disease specific approaches will not be considered. The studied discharge interventions will be categorised in at least one of the taxonomy classes identified by Hansen et al.22: - Predischarge intervention: patient education, discharge planning, medication reconciliation, appointment scheduled before discharge - Intervention bridging the transition: transition coach, patient-centred discharge instructions, provider continuity - Postdischarge intervention: timely follow-up, timely primary care provider communication, follow-up telephone call, patient hotline, home visit. Types of outcomes In this review we will study readmissions within three months after discharge from hospital. Readmissions are defined as hospitalisation to the same or another hospital for any reason within three months after discharge. Longer discharge intervals will be excluded, because the more time TRUNCATED AT 350 WORDS.