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JAMA Network Open Aug 2021Shortcomings in the education of patients at hospital discharge are associated with higher risks for treatment failure and hospital readmission. Whether improving... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Shortcomings in the education of patients at hospital discharge are associated with higher risks for treatment failure and hospital readmission. Whether improving communication at discharge through specific interventions has an association with patient-relevant outcomes remains unclear.
OBJECTIVE
To conduct a systematic review and meta-analysis on the association of communication interventions at hospital discharge with readmission rates and other patient-relevant outcomes.
DATA SOURCES
PubMed, EMBASE, PsycINFO, and CINAHL were systematically searched from the inception of each database to February 28, 2021.
STUDY SELECTION
Randomized clinical trials that randomized patients to receiving a discharge communication intervention or a control group were included.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data on outcomes and trial and patient characteristics. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Data were pooled using a random-effects model, and risk ratios (RRs) with corresponding 95% CIs are reported. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
MAIN OUTCOMES AND MEASURES
The primary outcome was hospital readmission, and secondary outcomes included adherence to treatment regimen, patient satisfaction, mortality, and emergency department reattendance 30 days after hospital discharge.
RESULTS
We included 60 randomized clinical trials with a total of 16 070 patients for the qualitative synthesis and 19 trials with a total of 3953 patients for the quantitative synthesis of the primary outcome. Of these, 11 trials had low risk of bias, 6 trials had high risk of bias, and 2 trials had unclear risk of bias. Communication interventions at discharge were significantly associated with lower readmission rates (179 of 1959 patients [9.1%] in intervention groups vs 270 of 1994 patients [13.5%] in control groups; RR, 0.69; 95% CI, 0.56-0.84), higher adherence to treatment regimen (1729 of 2009 patients [86.1%] in intervention groups vs 1599 of 2024 patients [79.0%] in control groups; RR, 1.24; 95% CI, 1.13-1.37), and higher patient satisfaction (1187 of 1949 patients [60.9%] in intervention groups vs 991 of 2002 patients [49.5%] in control groups; RR, 1.41; 95% CI, 1.20-1.66).
CONCLUSIONS AND RELEVANCE
These findings suggest that communication interventions at discharge are significantly associated with fewer hospital readmissions, higher treatment adherence, and higher patient satisfaction and thus are important to facilitate the transition of care.
Topics: Adult; Aged; Aged, 80 and over; Communication; Female; Humans; Male; Middle Aged; Patient Discharge; Patient Education as Topic; Patient Readmission; Practice Guidelines as Topic
PubMed: 34448868
DOI: 10.1001/jamanetworkopen.2021.19346 -
International Journal of Environmental... Jul 2019Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital...
Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.
Topics: Delivery of Health Care; Humans; Patient Discharge; Patient Readmission
PubMed: 31295933
DOI: 10.3390/ijerph16142457 -
The Lancet. Digital Health Mar 2023
Topics: Humans; Patient Discharge
PubMed: 36754724
DOI: 10.1016/S2589-7500(23)00021-3 -
Journal of Perinatology : Official... Mar 2022
Topics: Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Parents; Patient Discharge
PubMed: 35165373
DOI: 10.1038/s41372-022-01310-y -
BMC Geriatrics Mar 2020Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions... (Randomized Controlled Trial)
Randomized Controlled Trial
Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial.
BACKGROUND
Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations.
TRIAL DESIGN AND METHODS
This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics.
RESULTS
Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization (p = 0.003) and ED presentations (p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations (p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles (p = 0.019), the participation observed in HOME patients with no support was not significantly improved.
CONCLUSIONS
Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home.
TRIAL REGISTRATION
The trial was registered before commencement (ACTRN12611000615987).
Topics: Activities of Daily Living; Aftercare; Aged; Aged, 80 and over; Australia; Cognitive Dysfunction; Female; Humans; Male; Occupational Therapy; Outcome and Process Assessment, Health Care; Patient Discharge; Patient-Centered Care; Treatment Outcome
PubMed: 32122311
DOI: 10.1186/s12877-020-1494-3 -
Danish Medical Journal Nov 2022Enhanced recovery after surgery was developed based on the question "Why is the patient in hospital?" and is evolving in the context of multimodal perioperative care...
Enhanced recovery after surgery was developed based on the question "Why is the patient in hospital?" and is evolving in the context of multimodal perioperative care programmes with documented major benefits with respect to the need for hospitalisation and the risk of complications. Despite being a worldwide success, future challenges to improvements include patient and procedure-specific modification of inflammatory/immunological stress responses, improvement of post-discharge recovery, closing the knowing-doing gap between scientific evidence and clinical practice, and improving research design strategies.
Topics: Humans; Aftercare; Enhanced Recovery After Surgery; Patient Discharge; Hospitalization; Hospitals
PubMed: 36458610
DOI: No ID Found -
Journal of Perinatology : Official... Mar 2022The National Perinatal Association (NPA) coordinated a multidisciplinary work group to develop guidelines and recommendations for Neonatal Intensive Care Unit (NICU)... (Review)
Review
The National Perinatal Association (NPA) coordinated a multidisciplinary work group to develop guidelines and recommendations for Neonatal Intensive Care Unit (NICU) discharge preparation and thus the transition from NICU to home for infants admitted to the NICU and their families. In this section, we explore the concepts of NICU discharge readiness as well as transition planning and preparation. We describe the process that was used to develop the guidelines and recommendations as well as the timeline for the work. NPA hopes that the readers will find the Interdisciplinary Guidelines and Recommendations for NICU Discharge Preparation and Transition Planning to be beneficial, useful, and pertinent.
Topics: Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Patient Discharge; Pregnancy
PubMed: 35165375
DOI: 10.1038/s41372-022-01312-w -
Journal of Perinatology : Official... Mar 2022In this section, we present Interdisciplinary Guidelines and Recommendations for Neonatal Intensive Care Unit (NICU) Discharge Preparation and Transition Planning. The... (Review)
Review
In this section, we present Interdisciplinary Guidelines and Recommendations for Neonatal Intensive Care Unit (NICU) Discharge Preparation and Transition Planning. The foundation for these guidelines and recommendations is based on existing literature, practice, available policy statements, and expert opinions. These guidelines and recommendations are divided into the following sections: Basic Information, Anticipatory Guidance, Family and Home Needs Assessment, Transfer and Coordination of Care, and Other Important Considerations. Each section includes brief introductory comments, followed by the text of the guidelines and recommendations in table format. After each table, there may be further details or descriptions that support a guideline or recommendation. Our goal was to create recommendations that are both general and adaptable while also being specific and actionable. Each NICU's implementation of this guidance will be dependent on the unique makeup and skills of their team, as well as the availability of local programs and resources. The recommendations based only on expert opinion could be topics for future research.
Topics: Humans; Infant, Newborn; Intensive Care Units, Neonatal; Patient Discharge
PubMed: 35165374
DOI: 10.1038/s41372-022-01313-9 -
Emergencias : Revista de La Sociedad...
Topics: Aged; Emergency Service, Hospital; Frailty; Heart Failure; Humans; Patient Discharge; Physical Examination
PubMed: 32125123
DOI: No ID Found -
The Journal of Surgical Research Dec 2021As postoperative length of stay has decreased for many operations, the proportion of complications occurring post-discharge is increasing. Early identification and...
INTRODUCTION
As postoperative length of stay has decreased for many operations, the proportion of complications occurring post-discharge is increasing. Early identification and management of these complications requires overcoming barriers to effective post-discharge monitoring and communication. The aim of this study was to identify barriers to post-discharge monitoring and patient-clinician communication through a qualitative study of surgical patients and clinicians.
MATERIALS AND METHODS
Semi-structured interviews and focus groups were held with gastrointestinal surgery patients and clinicians. Participants were asked about barriers to post-discharge monitoring and communication. Each transcript was coded by 2 of 4 researchers, and recurring themes related to communication and care barriers were identified.
RESULTS
A total of 15 patients and 17 clinicians participated in interviews and focus groups. Four themes which encompassed barriers to post-discharge monitoring and communication were identified from patient interviews, and 4 barriers were identified from clinician interviews and focus groups. Patient-identified barriers included education and expectation setting, technology access and literacy, availability of resources and support, and misalignment of communication preferences, while clinician-identified barriers included health education, access to clinical team, healthcare practitioner time constraints, and care team experience and consistency.
CONCLUSIONS
Multiple barriers exist to effective post-discharge monitoring and patient-clinician communication among surgical patients. These barriers must be addressed to develop an effective system for post-discharge care after surgery.
Topics: Aftercare; Communication; Communication Barriers; Focus Groups; Humans; Patient Discharge; Qualitative Research
PubMed: 34274626
DOI: 10.1016/j.jss.2021.06.032