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Knee Surgery, Sports Traumatology,... Mar 2023The purpose of this study was to evaluate the effectiveness of day-case unicompartmental knee arthroplasty (UKA) by assessment of successful same-day discharge (SDD),... (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of this study was to evaluate the effectiveness of day-case unicompartmental knee arthroplasty (UKA) by assessment of successful same-day discharge (SDD), readmission, complication and reoperation rates in the recent literature.
METHODS
For this systematic review and meta-analysis, PubMed, Embase and Cochrane Library were comprehensively searched to identify all eligible studies reporting outcomes of day-case UKA. Studies with intended same-day home discharge after UKA were included. A meta-analysis of proportions, using a random-effects model, was performed to estimate overall rates of successful SDD and adverse events. Subgroup analyses were performed for studies including selected patients (i.e., patients had to meet certain patient-specific criteria to be eligible for day-case UKA) and unselected patients (i.e., no additional criteria for day-case UKA), as well as for clinical and registry-based studies. Additional outcomes included reasons for the failure of SDD and patient satisfaction.
RESULTS
A total of 29 studies and 9694 patients were included with a mean age of 66 ± 9 years and mean follow-up of 59 days (mean range 30-270 days). Based on 24 studies (2733 patients), the overall successful SDD rate was 88% (95% confidence interval [CI] 80-92). These rates were 91% (95% CI 84-95) across studies with selected patients and 76% (95% CI 55-89) across studies with unselected patients. Overall readmission, complication and reoperation rates were 3% (95% CI 1.9-4.4), 4% (95% CI 2.8-5.2) and 1% (95% CI 0.8-1.3), respectively. Inability to mobilize, nausea and uncontrolled pain were frequently reported reasons for failed SDD. The overall patient satisfaction rate was 94%.
CONCLUSION
This systematic review with meta-analysis found an overall successful SDD rate of 88% after UKA in a heterogeneous cohort of selected and unselected patients. Readmission, complication and reoperation rates suggest UKA can be performed safely and effectively as a same-day discharge procedure.
LEVEL OF EVIDENCE
Level IV, systematic review of level III and IV studies.
Topics: Humans; Infant; Arthroplasty, Replacement, Knee; Knee Joint; Osteoarthritis, Knee; Patient Discharge; Reoperation; Second-Look Surgery; Treatment Outcome
PubMed: 35951077
DOI: 10.1007/s00167-022-07094-0 -
Medicine Sep 2022This study investigated the effect of real-time feedback on the restoration of spontaneous circulation, survival to hospital discharge, and favorable functional outcomes... (Meta-Analysis)
Meta-Analysis
PURPOSE
This study investigated the effect of real-time feedback on the restoration of spontaneous circulation, survival to hospital discharge, and favorable functional outcomes after hospital discharge.
METHODS
PubMed, ScienceDirect, and China National Knowledge Infrastructure databases were searched to screen the relevant studies up to June 2020. Fixed-effects or random-effects model were used to calculate the pooled estimates of relative ratios (RRs) with 95% confidence intervals (CIs).
RESULTS
Ten relevant articles on 4281 cardiac arrest cases were identified. The pooled analyses indicated that real-time feedback did not improve restoration of spontaneous circulation (RR: 1.13, 95% CI: 0.92-1.37, and P = .24; I2 = 81%; P < .001), survival to hospital discharge (RR: 1.27, 95% CI: 0.90-1.79, and P = .18; I2 = 74%; P < .001), and favorable neurological outcomes after hospital discharge (RR: 1.09, 95% CI: 0.87-1.38; P = .45; I2 = 16%; P = .31). The predefined subgroup analysis showed that the sample size and arrest location may be the origin of heterogeneity. Begg's and Egger's tests showed no publication bias, and sensitivity analysis indicated that the results were stable.
CONCLUSION
The meta-analysis had shown that the implementation of real-time audiovisual feedback was not associated with improved restoration of spontaneous circulation, increased survival, and favorable functional outcomes after hospital discharge.
Topics: Cardiopulmonary Resuscitation; China; Humans; Out-of-Hospital Cardiac Arrest; Patient Discharge
PubMed: 36123918
DOI: 10.1097/MD.0000000000030438 -
Research in Social & Administrative... May 2020One of the strategies to promote patient safety in care transitions is medication reconciliation (MR), which is conducted by the pharmacist at the patient's discharge... (Review)
Review
BACKGROUND
One of the strategies to promote patient safety in care transitions is medication reconciliation (MR), which is conducted by the pharmacist at the patient's discharge from hospital. However, there are divergences about this process and about the pharmacist's role in conducting such intervention.
OBJECTIVE
To systematically review the literature that reports the MR process led by pharmacists at patient discharge and map the different methods, strategies and tools used in the process.
METHODS
Relevant studies were searched in the following databases: EMBASE, MEDLINE (PubMed), The Cochrane Library, and LILACS. No language restriction or publication date was applied. The studies considered eligible were those involving and describing pharmacist-led MR processes at acute patient discharge from hospital, with an experimental, quasi-experimental, or observational design. The characteristics of the studies and the MR processes were identified and then a qualitative synthesis was performed.
RESULTS
Fifty studies were included. The majority of them were observational ones (82%), and the main outcome was medication discrepancies (42%). The studies were mostly conducted in university hospitals (70%) and in internal medicine wards (54%). Pharmacists were responsible mainly for gathering medication histories (72%), and identifying (96%) and solving (98%) pharmacotherapeutic problems. The main sources of information on pre-admission medications were patient/caregiver interviews (66%) and records from other care providers (40%). Only 30% of the studies described a patient discharge plan, and 14% shared information of the patient's pharmacotherapy with community pharmacists.
CONCLUSION
The concept of MR and the pharmacist-led activities in the process varied in the literature, as well as the pharmacotherapy assessment focus and the communication strategies towards patients and other care providers, showing that standardization of the process and concepts is necessary.
Topics: Hospitals; Humans; Medication Reconciliation; Patient Discharge; Patient Transfer; Pharmacists; Pharmacy Service, Hospital
PubMed: 31395445
DOI: 10.1016/j.sapharm.2019.08.001 -
BMC Health Services Research Mar 2019The medical discharge letter is an important communication tool between hospitals and other healthcare providers. Despite its high status, it often does not meet the...
BACKGROUND
The medical discharge letter is an important communication tool between hospitals and other healthcare providers. Despite its high status, it often does not meet the desired requirements in everyday clinical practice. Occurring risks create barriers for patients and doctors. This present review summarizes risks of the medical discharge letter.
METHODS
The research question was answered with a systematic literature research and results were summarized narratively. A literature search in the databases PubMed and Cochrane Library for Studies between January 2008 and May 2018 was performed. Two authors reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Literature on possible risks associated with the medical discharge letter was discussed.
RESULTS
In total, 29 studies were included in this review. The major identified risk factors are the delayed sending of the discharge letter to doctors for further treatments, unintelligible (not patient-centered) medical discharge letters, low quality of the discharge letter, and lack of information as well as absence of training in writing medical discharge letters during medical education.
CONCLUSIONS
Multiple risks factors are associated with the medical discharge letter. There is a need for further research to improve the quality of the medical discharge letter to minimize risks and increase patients' safety.
Topics: Communication; Health Personnel; Hospitals; Humans; Medical Records; Narration; Patient Discharge; Patient Safety; Professional Practice
PubMed: 30866908
DOI: 10.1186/s12913-019-3989-1 -
Thorax Apr 2024Previous systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Previous systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD.
METHODS
An update of a previous Cochrane review was undertaken using the Cochrane Airways Review Group Specialised Register. Searches were conducted from October 2015 to August 2023 for studies that initiated pulmonary rehabilitation within 3 weeks of hospital discharge. Studies assessing the impact of solely inpatient pulmonary rehabilitation were excluded. Forest plots were generated using a generic inverse variance random effects method.
RESULTS
Seventeen studies were included. Posthospital discharge pulmonary rehabilitation reduced hospital re-admissions (OR 0.48, 95% CI 0.30 to 0.77, I=67%), improved exercise capacity (6 min walk test, mean difference (MD) 57 m, 95% CI 29 to 86, I=89%; incremental shuttle walk test, MD 43 m, 95% CI 6 to 79, I=81%), health-related quality of life (St. George's Respiratory Questionnaire, MD -8.7 points, 95% CI -12.5 to -4.9, I=59%; Chronic Respiratory Disease Questionnaire (CRQ)-emotion, MD 1.0 points, 95% CI 0.4 to 1.6, I=74%; CRQ-fatigue, MD 0.9 points, 95% CI 0.1 to 1.6, I=91%), and dyspnoea (CRQ-dyspnoea, MD 1.0 points, 95% CI 0.3 to 1.7, I=87%; modified Medical Research Council Dyspnoea Scale, MD -0.3 points, 95% CI -0.5 to -0.1, I=60%). Significant effects were not observed for CRQ-mastery, COPD assessment test, EuroQol-5 Dimension-5 Level and mortality. No intervention-related adverse events were reported.
DISCUSSION
Pulmonary rehabilitation delivered posthospital discharge for exacerbation of COPD results in a reduction in hospital re-admissions and improvements in exercise capacity, health-related quality of life and dyspnoea in the absence of any intervention-related adverse events.
TRIAL REGISTRATION NUMBER
CRD42023406397.
Topics: Humans; Patient Discharge; Quality of Life; Pulmonary Disease, Chronic Obstructive; Patient Readmission; Dyspnea
PubMed: 38350731
DOI: 10.1136/thorax-2023-220333 -
Journal of Clinical Nursing Oct 2015To compare the effectiveness of nurse-led early discharge planning programmes to standard care for inpatients with chronic disease or rehabilitation needs. (Meta-Analysis)
Meta-Analysis Review
Effectiveness of nurse-led early discharge planning programmes for hospital inpatients with chronic disease or rehabilitation needs: a systematic review and meta-analysis.
AIMS AND OBJECTIVES
To compare the effectiveness of nurse-led early discharge planning programmes to standard care for inpatients with chronic disease or rehabilitation needs.
BACKGROUND
Nurse-directed early discharge planning could shorten inpatient stays and reduce medical costs; however, it is not known whether the development of discharge planning programmes is effective for inpatients with chronic disease nor how such programmes might be optimally organised.
DESIGN
Systematic review and meta-analysis.
METHODS
The PubMed, MEDLINE, EMBASE, CINAHL and Cochrane Library were searched for randomized controlled trials assessing nurse-directed discharge planning for inpatients with chronic disease or rehabilitation needs. Two reviewers independently extracted data and assessed risk of bias. Meta-analyses were conducted for the eligible studies by RevMan 5.2.6. Data were pooled using a fixed-effect or random effects model. Where meta-analysis was not possible, narrative analysis was reported.
RESULTS
Ten randomized controlled trials and 3438 participants were included. Meta-analysis demonstrated that, compared to standard care, early discharge planning programmes are effective in reducing hospital readmission rates, duration of inpatient readmissions and all-cause mortality. However, no reduction in the length of stay of the index admission was demonstrated. Narrative analysis suggested that discharge planning may reduce total and readmission costs, as well as improving patients' satisfaction and overall quality of life.
CONCLUSIONS
Compared to standard care, nurse-led early discharge planning programmes have a positive impact on several aspects of care for inpatients with chronic disease and rehabilitation requirements, including reducing readmission, readmission length of stay and mortality and improving quality of life. These findings should be taken into account in future health service policy development.
RELEVANCE TO CLINICAL PRACTICE
These findings are relevant to clinical and managerial staff in formulating and implementing discharge planning programmes for inpatients with chronic disease or rehabilitation needs.
Topics: Chronic Disease; Humans; Needs Assessment; Nurse's Role; Patient Discharge; Patient Readmission; Quality of Life
PubMed: 26095175
DOI: 10.1111/jocn.12895 -
Disability and Rehabilitation Sep 2022To identify which of the socio-environmental factors of patients with stroke are predictive for discharge to their home after inpatient rehabilitation. Because discharge... (Meta-Analysis)
Meta-Analysis
PURPOSE
To identify which of the socio-environmental factors of patients with stroke are predictive for discharge to their home after inpatient rehabilitation. Because discharge planning is a key component of rehabilitation, it is important to recognize the predictive factors for a discharge home. Other systematic reviews demonstrated the value of functional outcome measures. This review adds to the current literature by assessing the predictive value of socio-environmental factors, which shape the context in which a person lives.
METHODS
We performed a systematic search in seven databases. Two independent reviewers selected studies and assessed them for methodological quality. We extracted data to estimate pooled odds ratio for household situation, social support, ethnicity and socioeconomic status.
RESULTS
Forty studies were included. Significant estimates were found for living with others (OR 2.60; 95%CI 1.84-3.68), having support at home (OR 11.48; 95%CI 6.52-20.21), being married (OR 2.05; 95%CI 1.80-2.33) and living at home before stroke (OR 31.01; 95%CI 7.38-130.18).
CONCLUSION
Living at home and benefiting from social support, including living with others, are important factors to consider during discharge planning after stroke. Further research should consider the impact of socioeconomic status.IMPLICATIONS FOR REHABILITATIONEvaluating the social and environmental factors of patients with stroke plays an important role in discharge planning.Next to functional status, caregiver availability (support at home) is among the strongest predictive factors for discharge home.To assess caregiver availability, the presence of a willing and able caregiver should be surveyed at admission.Further predictive factors for discharge home are cohabitation and marital status.
Topics: Caregivers; Humans; Inpatients; Patient Discharge; Stroke; Stroke Rehabilitation
PubMed: 34004119
DOI: 10.1080/09638288.2021.1923838 -
BMJ Quality & Safety Apr 2018Pharmacists' completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pharmacists' completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload.
METHODS
This is a systematic literature review and meta-analysis of extracted data. Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Allied and Complementary Medicine Database (AMED),Education Resources Information Center (ERIC), Scopus, NHS Evidence and the Cochrane databases were searched using a combination of medical subject heading terms and free-text search terms. Controlled studies evaluating pharmacist-led medication reconciliation in the community after hospital discharge were included. Study quality was appraised using the Critical Appraisal Skills Programme. Evidence was assessed through meta-analysis of readmission rates. Discrepancy identification rates, emergency department attendance and primary care workload were assessed narratively.
RESULTS
Fourteen studies were included, comprising five randomised controlled trials, six cohort studies and three pre-post intervention studies. Twelve studies had a moderate or high risk of bias. Increased identification and resolution of discrepancies was demonstrated in the four studies where this was evaluated. Reduction in clinically relevant discrepancies was reported in two studies. Meta-analysis did not demonstrate a significant reduction in readmission rate. There was no consistent evidence of reduction in emergency department attendance or primary care workload.
CONCLUSIONS
Pharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge, but patient outcome or care workload improvements were not consistently seen. Future research should examine the clinical relevance of discrepancies and potential benefits on reducing healthcare team workload.
Topics: Medication Reconciliation; Patient Discharge; Pharmacists; Professional Role
PubMed: 29248878
DOI: 10.1136/bmjqs-2017-007087 -
Endocrine Practice : Official Journal... Apr 2021The transition of diabetes care from home to hospital, within the hospital, and upon discharge is fraught with gaps that can adversely affect patient safety and length... (Review)
Review
OBJECTIVE
The transition of diabetes care from home to hospital, within the hospital, and upon discharge is fraught with gaps that can adversely affect patient safety and length of stay. We aimed to highlight the variability in care during these transitions and point out areas where research is needed.
METHODS
A PubMed search was performed with a combination of search terms that pertained to diabetes, hyperglycemia, hospitalization, locations in the hospital, discharge to home or a nursing facility, and diabetes medications. Studies with at least 50 patients that were written in the English language were included.
RESULTS
With the exception of transitioning from intravenous insulin infusion to subcutaneous insulin and perhaps admission to the regular floors, few studies pointedly focused on transitions of care, leading us to extrapolate recommendations based on data from disparate areas of care in the hospital. There is evidence at every stage of care, starting from the entry into the hospital and ending with discharge home or to a facility, that patients benefit from having protocols in place guiding overall care.
CONCLUSION
Pockets of care exist in hospitals where methods of effective diabetes management have been studied and implemented. However, there is no sustained continuum of care. Protocols and care teams that follow patients from one physical location to the other may result in improved clinical outcomes during and following a hospital stay.
Topics: Hospitalization; Humans; Hyperglycemia; Inpatients; Insulin; Patient Discharge
PubMed: 33529732
DOI: 10.1016/j.eprac.2021.01.016 -
The American Journal of Occupational... Jan 2022Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating...
Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions.
IMPORTANCE
Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs.
OBJECTIVE
In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission.
DATA SOURCES
We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
FINDINGS
We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.
Topics: Accidental Falls; Aged; Humans; Medicare; Occupational Therapy; Patient Discharge; Patient Readmission; Subacute Care; United States
PubMed: 34967846
DOI: 10.5014/ajot.2022.049044