Preventing the rebound: improving care transition in hospital discharge processes.
BACKGROUND
Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions.


OBJECTIVE
To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre- and postdischarge elements.


METHODS
Systematic metareview of controlled trials.


METHODS
Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions.


RESULTS
Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure.


CONCLUSIONS
Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre- and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospital–community interface.
Princess Alexandra Hospital, Level 5A, Ipswich Road, Brisbane, QLD 4102, Australia. ian_scott@health.qld.gov.au
Ian A
IA
Scott
D003152:Community Health Nursing / Q000379:methods / Q000592:standards; D003266:Continuity of Patient Care / Q000592:standards*; D018849:Controlled Clinical Trials as Topic; D006699:Home Care Services / Q000592:standards; D006801:Humans; D010351:Patient Discharge / Q000592:standards*; D010353:Patient Education as Topic; D010359:Patient Readmission; D012648:Self Care