Fariba Aghajafari1, Sayeeda Sayed2, Nader Emami3, Eddy Lang4, Joanna Abraham5. 1. Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: fariba.aghajafari@ucalgary.ca. 2. Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. College of Dentistry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. 4. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 5. Department of Anesthesiology - Clinical Research, Washington University in St. Louis, St. Louis, MO, United States of America.
Abstract
INTRODUCTION: Suboptimal transitions from the emergency department (ED) to outpatient settings can result in poor care continuity, and subsequently higher costs to the healthcare system. We aimed to systematically review care transition interventions (CTIs) for adult patients to understand how effective ED-based CTIs are in reducing return visits to the ED and increasing follow-up visits with primary care physicians. METHODS: We searched multiple databases and identified eligible published RCTs of ED-based CTIs affecting outpatient follow-up rates, ED readmission and hospital admission. Two independent authors reviewed titles and abstracts for potential inclusion and selected studies for full review. Study quality was assessed using the Cochrane risk-of-bias tool. ED-based CTIs were classified using a care continuity framework. RESULTS: Our search generated 28,807 articles; 112 were selected for full-text review. Data were abstracted from 42 articles that met inclusion criteria. Pooling data from 20 studies (n = 8178 patients) found a relative increase in outpatient follow-up with ED-based CTIs compared to routine care (odds ratio 1.79, 95% confidence interval [CI] 1.43, 2.24). However, ED-based CTIs (20 studies, n = 8048 patients) had no significant effect on ED readmissions (odds ratio 1.02, 95% CI 0.87, 1.20]) or hospital admission after ED discharge (13 studies, n = 5742 patients) (odds ratio 0.99, 95% CI 0.86, 1.14) when compared to routine care. Twenty-two studies encompassed CTIs supporting all three functions of care continuity (information, communication and coordination). CONCLUSIONS: ED-based CTIs do not appear to reduce ED revisit or hospital admission after ED discharge but are effective in increasing follow-up.
INTRODUCTION: Suboptimal transitions from the emergency department (ED) to outpatient settings can result in poor care continuity, and subsequently higher costs to the healthcare system. We aimed to systematically review care transition interventions (CTIs) for adult patients to understand how effective ED-based CTIs are in reducing return visits to the ED and increasing follow-up visits with primary care physicians. METHODS: We searched multiple databases and identified eligible published RCTs of ED-based CTIs affecting outpatient follow-up rates, ED readmission and hospital admission. Two independent authors reviewed titles and abstracts for potential inclusion and selected studies for full review. Study quality was assessed using the Cochrane risk-of-bias tool. ED-based CTIs were classified using a care continuity framework. RESULTS: Our search generated 28,807 articles; 112 were selected for full-text review. Data were abstracted from 42 articles that met inclusion criteria. Pooling data from 20 studies (n = 8178 patients) found a relative increase in outpatient follow-up with ED-based CTIs compared to routine care (odds ratio 1.79, 95% confidence interval [CI] 1.43, 2.24). However, ED-based CTIs (20 studies, n = 8048 patients) had no significant effect on ED readmissions (odds ratio 1.02, 95% CI 0.87, 1.20]) or hospital admission after ED discharge (13 studies, n = 5742 patients) (odds ratio 0.99, 95% CI 0.86, 1.14) when compared to routine care. Twenty-two studies encompassed CTIs supporting all three functions of care continuity (information, communication and coordination). CONCLUSIONS: ED-based CTIs do not appear to reduce ED revisit or hospital admission after ED discharge but are effective in increasing follow-up.
Authors: Justine Seidenfeld; Karen M Stechuchak; Cynthia J Coffman; Elizabeth P Mahanna; Micaela N Gladney; Susan N Hastings Journal: Am J Emerg Med Date: 2021-09-16 Impact factor: 4.093
Authors: Cameron J Gettel; Corrine I Voils; Alycia A Bristol; Lynne D Richardson; Teresita M Hogan; Abraham A Brody; Micaela N Gladney; Joe Suyama; Luna C Ragsdale; Christine L Binkley; Carmen L Morano; Justine Seidenfeld; Nada Hammouda; Kelly J Ko; Ula Hwang; Susan N Hastings Journal: Acad Emerg Med Date: 2021-08-23 Impact factor: 3.451
Authors: Gwen C Jacobsohn; Courtney M C Jones; Rebecca K Green; Amy L Cochran; Thomas V Caprio; Jeremy T Cushman; Amy J H Kind; Michael Lohmeier; Ranran Mi; Manish N Shah Journal: Acad Emerg Med Date: 2021-08-20 Impact factor: 3.451