Cedric Mabire1, Andrew Dwyer, Antoine Garnier, Joanie Pellet. 1. 1University of Applied Sciences and Arts Western Switzerland (HES-SO), School of Health Sciences (HESAV), Lausanne, Vaud, Switzerland 2Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence 3Institute of Higher Education and Research in Healthcare (IUFRS), Lausanne University and CHUV, Vaud, Switzerland 4Lausanne University Hospital - CHUV, Lausanne, Vaud, Switzerland.
Abstract
BACKGROUND: Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice. OBJECTIVES: To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Elderly inpatients aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals to home. TYPES OF INTERVENTIONS: The review focused on the six keys components of Naylor's Transitional Care Model: early geriatric assessment, discharge preparation, patient or caregiver's participation, continuity of care, day of discharge assessment and post-discharge follow-up. TYPES OF STUDIES: This review considered randomized and non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. OUTCOMES: The outcomes for this review were functional ability, symptoms management, adverse outcomes, unmet needs after discharge, coping with disease, health-related quality of life (QoL), satisfaction with care, readmission rate and healthcare utilization. SEARCH STRATEGY: A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000 and 2015. METHODOLOGICAL QUALITY: Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Quantitative data were extracted from included studies independently by the two reviewers using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS: Due to the wide range of outcome measures, a comprehensive meta-analysis for all studies was not possible. However, meta-analysis was conducted for specific outcome measures, such as readmission, length of stay and QoL. RESULTS: Thirteen studies met the inclusion criteria and were included in the review. Two out of the 13 studies were pilot studies and one had a pre-post design. Included studies involved a total of 3964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission rate (odds ratio [OR] = 0.73, 95% confidence intervals [CIs] = 0.53-1.01, P = 0.06). The overall effect score for length of stay was significant (weighted mean difference = 0.29, P < 0.01), suggesting that discharge planning increased the length of hospitalization. The effectiveness of discharge planning did not significantly impact QoL (mental OR = 0.37, P = 0.19 and physical OR = 0.47, P = 0.15). CONCLUSION: Findings of this review suggest that nursing discharge planning for elderly inpatients discharged home increases length of stay, yet neither reduces readmission rates nor improves QoL.
BACKGROUND: Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice. OBJECTIVES: To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Elderly inpatients aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals to home. TYPES OF INTERVENTIONS: The review focused on the six keys components of Naylor's Transitional Care Model: early geriatric assessment, discharge preparation, patient or caregiver's participation, continuity of care, day of discharge assessment and post-discharge follow-up. TYPES OF STUDIES: This review considered randomized and non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. OUTCOMES: The outcomes for this review were functional ability, symptoms management, adverse outcomes, unmet needs after discharge, coping with disease, health-related quality of life (QoL), satisfaction with care, readmission rate and healthcare utilization. SEARCH STRATEGY: A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000 and 2015. METHODOLOGICAL QUALITY: Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Quantitative data were extracted from included studies independently by the two reviewers using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS: Due to the wide range of outcome measures, a comprehensive meta-analysis for all studies was not possible. However, meta-analysis was conducted for specific outcome measures, such as readmission, length of stay and QoL. RESULTS: Thirteen studies met the inclusion criteria and were included in the review. Two out of the 13 studies were pilot studies and one had a pre-post design. Included studies involved a total of 3964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission rate (odds ratio [OR] = 0.73, 95% confidence intervals [CIs] = 0.53-1.01, P = 0.06). The overall effect score for length of stay was significant (weighted mean difference = 0.29, P < 0.01), suggesting that discharge planning increased the length of hospitalization. The effectiveness of discharge planning did not significantly impact QoL (mental OR = 0.37, P = 0.19 and physical OR = 0.47, P = 0.15). CONCLUSION: Findings of this review suggest that nursing discharge planning for elderly inpatients discharged home increases length of stay, yet neither reduces readmission rates nor improves QoL.
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