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International Journal of Nursing Studies Apr 2023There is some evidence to suggest that discharge education may reduce the risk of postoperative complications, however, a critical evaluation of the body of evidence is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is some evidence to suggest that discharge education may reduce the risk of postoperative complications, however, a critical evaluation of the body of evidence is needed.
OBJECTIVE
To assess the effect of discharge education interventions versus standard education given to general surgery patients prior to, or up to 30-days of hospital discharge on clinical and patient-reported outcomes.
DESIGN
Systematic review and meta-analysis. Clinical outcomes were 30-day surgical site infection incidence and re-admission up to 28 days. Patient-reported outcomes included patient knowledge, self-confidence, satisfaction, and quality of life.
SETTING
Participants were recruited from hospitals.
PARTICIPANTS
Adult general surgical patients.
METHODS
MEDLINE (Pubmed), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library were searched in February 2022. Randomised controlled trials and non-randomised studies of interventions published between 2010 and 2022, with adults undergoing general surgical procedures receiving discharge education on surgical recovery, including wound management, were eligible for inclusion. Quality appraisal was undertaken using the Cochrane Risk of Bias 2 and the Risk of Bias Assessment Tool for Nonrandomised Studies. The Grading of Assessment, Development, Recommendations, and Evaluation was used to assess the certainty of the body of evidence based on the outcomes of interest.
RESULTS
Ten eligible studies (eight randomised control trials and two non-randomised studies of interventions) with 965 patients were included. Six randomised control trials assessed the effect of discharge education interventions on 28-day readmission (Odds ratio 0.88, 95 % confidence interval 0.56-1.38). Two randomised control trials assessed the effect of discharge education interventions on surgical site infection incidence (Odds ratio = 0.84, 95 % confidence interval 0.39-1.82). The results of the non-randomised studies of interventions were not pooled due to heterogeneity in outcome measures. The risk of bias was either moderate or high for all outcomes, and the body of evidence using GRADE was judged as very low for all outcomes studied.
CONCLUSIONS
The impact of discharge education on the clinical and patient-reported outcomes of patients undergoing general surgery cannot be determined due to the uncertainty of the evidence base. Despite the increased use of web-based interventions to deliver discharge education to general surgery patients, larger samples in more rigorous multicentre randomised control trials with parallel process evaluations are needed to better understand the effect of discharge education on clinical and patient-reported outcomes.
REGISTRATION
PROSPERO CRD42021285392.
TWEETABLE ABSTRACT
Discharge education may reduce the likelihood of surgical site infection and hospital readmission but the body of evidence is inconclusive.
Topics: Adult; Humans; Surgical Wound Infection; Patient Discharge; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 36871540
DOI: 10.1016/j.ijnurstu.2023.104471 -
International Journal For Quality in... Oct 2017To systematically review the available evidence about hospital discharge communication practices and identify which practices were preferred by patients and healthcare... (Review)
Review
PURPOSE
To systematically review the available evidence about hospital discharge communication practices and identify which practices were preferred by patients and healthcare providers, improved patient and provider satisfaction, and increased patients' understanding of their medical condition.
DATA SOURCES
OVID Medline, Web of Science, ProQuest, PubMed and CINAHL plus.
STUDY SELECTION
Databases were searched for peer-reviewed, English-language papers, published to August 2016, of empirical research using quantitative or qualitative methods. Reference lists in the papers meeting inclusion criteria were searched to identify further papers.
DATA EXTRACTION
Of the 3489 articles identified, 30 met inclusion criteria and were reviewed.
RESULTS OF DATA SYNTHESIS
Much research to date has focused on the use of printed material and person-based discharge communication methods including verbal instructions (either in person or via telephone calls). Several studies have examined the use of information technology (IT) such as computer-generated and video-based discharge communication practices. Utilizing technology to deliver discharge information is preferred by healthcare providers and patients, and improves patients' understanding of their medical condition and discharge instructions.
CONCLUSION
Well-designed IT solutions may improve communication, coordination and retention of information, and lead to improved outcomes for patients, their families, caregivers and primary healthcare providers as well as expediting the task for hospital staff.
Topics: Communication; Health Personnel; Humans; Medical Informatics; Patient Discharge; Patient Preference; Patient Satisfaction; Professional-Patient Relations
PubMed: 29025093
DOI: 10.1093/intqhc/mzx121 -
Journal of Affective Disorders Dec 2017Patients with depression require treatment continuity when discharged from inpatient care. Interventions aimed at optimizing transition into outpatient care may be... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patients with depression require treatment continuity when discharged from inpatient care. Interventions aimed at optimizing transition into outpatient care may be effective in preventing symptom deterioration and readmission. We aimed to evaluate the effectiveness of care transition interventions for patients with depression after psychiatric hospitalization.
METHODS
Systematic review and random-effects meta-analysis of controlled trials. Primary outcomes were readmissions and symptoms of depression. The control condition was treatment as usual.
RESULTS
We included 16 publications reporting the results of 13 different studies. Studies were heterogeneous concerning patient selection and interventional approach. Effects on readmissions and depression symptoms were non-significant in meta-analysis of 8 studies/710 patients and 7 studies/592 patients, respectively. Overall risk ratio for readmission during follow-up was 0.65 (95% CI [0.42;1.01], p=0.06), standardized mean difference for depression symptoms was -0.09 (95% CI [-0.37;0.19], p=0.53). Subgroup analyses indicated no preference for a specific interventional strategy. Data point to considerable risk for selection and publication bias.
LIMITATIONS
Included studies are heterogeneous; subgroups are often small and may not attain the power to detect effects. Reasonable classification of interventions into groups of comparable approaches was a challenge and may be arbitrary in some cases.
CONCLUSIONS
This systematic review and meta-analysis could not identify any convincingly effective interventional transition approach for patients with depression after psychiatric hospitalization. Current evidence regarding discharge management for depression is limited, heterogeneous and potentially prone to bias. Interventions might be more appropriate for patients with other diagnoses than depression. Further high-quality randomized studies are required.
Topics: Cognitive Behavioral Therapy; Continuity of Patient Care; Depressive Disorder; Hospitalization; Humans; Patient Discharge; Transitional Care
PubMed: 28734149
DOI: 10.1016/j.jad.2017.07.026 -
Journal of Nursing Care Quality 2019This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge.
BACKGROUND
This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge.
PURPOSE
Improving patient flow and timely bed capacity is a global issue. Criteria-led discharge enables accelerated patient discharge in accordance with patient selection.
METHODS
A systematic review was conducted to identify literature on criteria-led discharge from 2007 to 2017. The quality of articles was appraised using a tool for disparate studies. Two reviewers extracted relevant data independently.
RESULTS
Fifteen studies were identified that showed no increase in patient readmission or complication rates with criteria-led discharge, demonstrating patient safety. The quality of the patient discharge was unremarkable. None of the studies showed an increase in length of stay.
CONCLUSIONS
The safety, quality, and length of stay for patients discharged through criteria-led discharge are inextricably linked to the process adopted for its implementation.
Topics: Humans; Length of Stay; Patient Discharge; Patient Readmission; Patient Selection; Time Factors
PubMed: 30198948
DOI: 10.1097/NCQ.0000000000000356 -
World Journal of Urology Jun 2022Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging...
PURPOSE
Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging patients within 24 h, reducing costs and length of stay, and facilitating return to active life. We perform a systematic review of literature to evaluate the feasibility of SDD RP.
METHODS
A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Embase. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines.
RESULTS
Based on the literature search of 509 articles, 12 (1378 patients) met the inclusion criteria (mean age: 63 years). All studies were unicentric except one. The mean SDD surgeries experience per centre was 66 cases .The means operative time and blood loss were 154 min and 126.5 ml, respectively. Mean SDD failure was 7.4%. Concomitant lymph node dissection was performed in 56.2%. The overall complication rate was 10.2% of cases; with a majority of Clavien grade I or II. Mean readmission rate after discharge was 5%. SDD generated cost reductions compared to inpatient surgery with variable differences according to the considered healthcare system.
CONCLUSIONS
Day-case RP is a safe and feasible strategy in selected cases with multicentre proofs of concept. Its widespread use in routine practice needs further research due to biases in patient selection. Implementation of peri-operative pathways such as ERAS and prehabilitation improves patient adherence to SDD.
Topics: Feasibility Studies; Humans; Laparoscopy; Male; Middle Aged; Patient Discharge; Prostate; Prostatectomy
PubMed: 35157103
DOI: 10.1007/s00345-022-03944-1 -
Patient-Reported Opioid Analgesic Use After Discharge from Surgical Procedures: A Systematic Review.Pain Medicine (Malden, Mass.) Jan 2022This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use after surgery.
OBJECTIVE
This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use after surgery.
METHODS
We searched PubMed (February 2019) and Web of Science and Embase (June 2019) for U.S. studies describing patient-reported outpatient opioid analgesic use. Two reviewers extracted data on opioid analgesic use, standardized the data on use , and performed independent quality appraisals based on the Cochrane Risk of Bias Tool and an adapted Newcastle-Ottawa scale.
RESULTS
Ninety-six studies met the eligibility criteria; 56 had sufficient information to standardize use in oxycodone 5-mg tablets. Patient-reported opioid analgesic use varied widely by procedure type; knee and hip arthroplasty had the highest postoperative opioid use, and use after many procedures was reported as <5 tablets. In studies that examined excess tablets, 25-98% of the total tablets prescribed were reported to be excess, with most studies reporting that 50-70% of tablets went unused. Factors commonly associated with higher opioid analgesic use included preoperative opioid analgesic use, higher inpatient opioid analgesic use, higher postoperative pain scores, and chronic medical conditions, among others. Estimates also varied across studies because of heterogeneity in study design, including length of follow-up and inclusion/exclusion criteria.
CONCLUSION
Self-reported postsurgery outpatient opioid analgesic use varies widely both across procedures and within a given procedure type. Contributors to within-procedure variation included patient characteristics, prior opioid use, intraoperative and perioperative factors, and differences in the timing of opioid use data collection. We provide recommendations to help minimize variation caused by study design factors and maximize interpretability of forthcoming studies for use in clinical guidelines and decision-making.
Topics: Analgesics, Opioid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Pain, Postoperative; Patient Discharge; Patient Reported Outcome Measures
PubMed: 34347101
DOI: 10.1093/pm/pnab244 -
Pediatrics Aug 2017Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can... (Review)
Review
CONTEXT
Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a systematic review.
OBJECTIVE
To perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions.
DATA SOURCES
We consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017).
STUDY SELECTION
We selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated.
DATA EXTRACTION
Two authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form.
RESULTS
Sixty-four studies met inclusion criteria; most ( = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied ( = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis ( = 3), restrictions ( = 2), or equipment ( = 1). Complex discharge plans (eg, multiple medicines or appointments), limited English proficiency, and public or no insurance were associated with errors. Few researchers conducted studies that evaluated the role of parent health literacy (ED, = 5; inpatient, = 0).
LIMITATIONS
The studies were primarily observational in nature.
CONCLUSIONS
Parents frequently make errors related to knowledge and execution of inpatient and ED discharge instructions. Researchers in the future should assess parental management of instructions for domains that are less well studied and focus on the design of interventions to improve discharge plan management.
Topics: Child; Child, Hospitalized; Emergency Service, Hospital; Health Knowledge, Attitudes, Practice; Health Literacy; Humans; Parents; Patient Discharge
PubMed: 28739657
DOI: 10.1542/peds.2016-4165 -
Neurosurgical Review Apr 2023Overlapping surgery (OS) is a common practice in neurosurgery that has recently come under scrutiny. This study includes a systematic review and meta-analysis on... (Meta-Analysis)
Meta-Analysis Review
Overlapping surgery (OS) is a common practice in neurosurgery that has recently come under scrutiny. This study includes a systematic review and meta-analysis on articles evaluating the effects of OS on patient outcomes. PubMed and Scopus were searched for studies that analyzed outcome differences between overlapping and non-overlapping neurosurgical procedures. Study characteristics were extracted, and random-effects meta-analyses were performed to analyze the primary outcome (mortality) and secondary outcomes (complications, 30-day readmissions, 30-day operating room returns, home discharge, blood loss, and length of stay). Mantel-Haenszel tests were completed for binary outcomes, whereas the inverse variance tests were conducted for continuous outcomes. Heterogeneity was measured using the I and X tests. The Egger's test was conducted to evaluate publication bias. Eight of 61 non-duplicate studies were included. Overall, 21,249 patients underwent non-OS (10,504 female) and 15,863 patients underwent OS (8393 female). OS was associated with decreased mortality (p = 0.002), 30-day returns to OR (p < 0.001), and blood loss (p < 0.001) along with increased home discharges (p < 0.001). High heterogeneity was observed for home discharge (p = 0.002) and length of stay (p < 0.001). No publication bias was observed. OS was not associated with worse patient outcomes compared to non-OS. However, considering multiple sources of limitation in the methodology of the included studies (such as limited number of studies, reports originating from mostly high-volume academic centers, discrepancy in the definition of "critical portion(s)" of the surgery across studies, and selection bias), extra caution is advised in interpretation of our results and further focused studies are warranted.
Topics: Humans; Female; Neurosurgical Procedures; Patient Discharge; Operating Rooms; Neurosurgery
PubMed: 37072635
DOI: 10.1007/s10143-023-01993-7 -
International Journal of Cardiology Oct 2016The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless ventricular tachycardia. We reviewed the effects of amiodarone on survival and neurological outcome after cardiac arrest.
METHODS
We systematically searched MEDLINE and Cochrane Library from 1940 to March 2016 without language restrictions. Randomized control trials (RCTs) and observational studies were selected.
RESULTS
Our search initially identified 1663 studies, 1458 from MEDLINE and 205 from Cochrane Library. Of them, 4 randomized controlled studies and 6 observational studies met the inclusion criteria and were selected for further review. Three randomized studies were included in the meta-analysis. Amiodarone significantly improves survival to hospital admission (OR=1.402, 95% CI: 1.068-1.840, Z=2.43, P=0.015), but neither survival to hospital discharge (RR=0.850, 95% CI: 0.631-1.144, Z=1.07, P=0.284) nor neurological outcome compared to placebo or nifekalant (OR=1.114, 95% CI: 0.923-1.345, Z=1.12, P=0.475).
CONCLUSIONS
Amiodarone significantly improves survival to hospital admission. However there is no benefit of amiodarone in survival to discharge or neurological outcomes compared to placebo or other antiarrhythmics.
Topics: Amiodarone; Anti-Arrhythmia Agents; Heart Arrest; Humans; Observational Studies as Topic; Patient Admission; Patient Discharge; Randomized Controlled Trials as Topic; Survival Rate
PubMed: 27434349
DOI: 10.1016/j.ijcard.2016.07.138 -
World Neurosurgery Feb 2022Enhanced Recovery after Surgery (ERAS) pathways are increasingly being integrated in neurosurgical patient management. The full extent of ERAS in cranial surgery is not... (Review)
Review
BACKGROUND
Enhanced Recovery after Surgery (ERAS) pathways are increasingly being integrated in neurosurgical patient management. The full extent of ERAS in cranial surgery is not well studied. We performed a systematic review examining ERAS in cranial surgery patients to 1) identify the extent to which ERAS is integrated in cranial neurosurgical procedures and 2) assess effectiveness of ERAS interventions for patients undergoing these procedures.
METHODS
A systematic review of MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, PsychInfo, and Google Scholar was conducted according to PRISMA guidelines (CRD42020197187). Studies eligible for inclusion assessed patients undergoing any cranial surgical procedure using an ERAS or ERAS-like pathway, defined by ≥2 ERAS protocol elements per the ERAS Society's RECOvER Checklist and the recommendations of Hagan et al. 2016 (not including patient education, criteria for discharge, or tracking of postdischarge outcomes).
RESULTS
Nine studies were included in qualitative synthesis, 2 of which were randomized controlled trials. All studies showed a moderate risk of bias. The most common ERAS elements used were screening and/or optimization and formal discharge criteria. The least common ERAS elements used were fasting/carbohydrate loading and antithrombotic prophylaxis. Complication rates were similar in studies comparing ERAS with non-ERAS groups. ERAS interventions were associated with reduced length of stay, with comparable and/or improved patient satisfaction.
CONCLUSIONS
ERAS is a safe and potentially favorable perioperative pathway for select patients undergoing cranial surgery. Future studies of ERAS in cranial surgery patients should emphasize postoperative optimizations and patient-reported outcome measures as key features.
Topics: Aftercare; Enhanced Recovery After Surgery; Humans; Length of Stay; Patient Discharge; Postoperative Complications
PubMed: 34740831
DOI: 10.1016/j.wneu.2021.10.176