Discharge planning from hospital to home.
BACKGROUND
Discharge planning is a routine feature of health systems in many countries. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and improve the co-ordination of services following discharge from hospital.


OBJECTIVE
To determine the effectiveness of planning the discharge of patients moving from hospital.


METHODS
We updated the review using the Cochrane EPOC Group Trials Register, MEDLINE, EMBASE and the Social Science Citation Index (last searched in March 2009).


METHODS
Randomised controlled trials (RCTs) that compared an individualised discharge plan with routine discharge care that was not tailored to the individual patient. Participants were hospital inpatients.


METHODS
Two authors independently undertook data analysis and quality assessment using a predesigned data extraction sheet. Studies are grouped according to patient group (elderly medical patients, surgical patients and those with a mix of conditions) and by outcome.


RESULTS
Twenty-one RCTs (7234 patients) are included; ten of these were identified in this update. Fourteen trials recruited patients with a medical condition (4509 patients), four recruited patients with a mix of medical and surgical conditions (2225 patients), one recruited patients from a psychiatric hospital (343 patients), one from both a psychiatric hospital and from a general hospital (97 patients), and the final trial recruited patients admitted to hospital following a fall (60 patients). Hospital length of stay and readmissions to hospital were significantly reduced for patients allocated to discharge planning (mean difference length of stay -0.91, 95% CI -1.55 to -0.27, 10 trials; readmission rates RR 0.85, 95% CI 0.74 to 0.97, 11 trials). For elderly patients with a medical condition (usually heart failure) there was insufficient evidence for a difference in mortality (RR 1.04, 95% CI 0.74 to 1.46, four trials) or being discharged from hospital to home (RR 1.03, 95% CI 0.93 to 1.14, two trials). This was also the case for trials recruiting patients recovering from surgery and a mix of medical and surgical conditions. In three trials patients allocated to discharge planning reported increased satisfaction. There was little evidence on overall healthcare costs.


CONCLUSIONS
The evidence suggests that a structured discharge plan tailored to the individual patient probably brings about small reductions in hospital length of stay and readmission rates for older people admitted to hospital with a medical condition. The impact of discharge planning on mortality, health outcomes and cost remains uncertain.
Shepperd
Sasha
S
Department of Public Health, University of Oxford, Rosemary Rue Building, Headington, Oxford, Oxfordshire, UK, OX3 7LF.
McClaran
Jacqueline
J
Phillips
Christopher O
CO
Lannin
Natasha A
NA
Clemson
Lindy M
LM
McCluskey
Annie
A
Cameron
Ian D
ID
Barras
Sarah L
SL
D018849:Controlled Clinical Trials as Topic; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission; D016032:Randomized Controlled Trials as Topic