Effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia: A systematic review.
BACKGROUND
Hospital readmission soon after discharge is common and costly. To date, published studies of effectiveness of structured discharge process addressing reduction of hospital readmission have focused on patients with chronic conditions and complex needs, but not in adult patients with community acquired pneumonia.


OBJECTIVE
To examine and synthesise the best available evidence related to effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.


METHODS
This review considered studies that included hospitalised adult patients diagnosed with community acquired pneumonia regardless of gender, ethnicity, severity, and co-morbidities.Structured discharge process related to early patient engagement, patient-caregiver dyad intervention, transitional care, coordinated care, and multidisciplinary team approach.The outcome measures included in this review were hospital readmission, emergency room visits, and unscheduled visits to healthcare provider.Randomised controlled trials (RCTs) and quasi-experimental studies were considered for inclusion.


METHODS
The search strategy aimed to find both published and unpublished studies in English language without date limits. A search of PubMed/MEDLINE, CINAHL, CINAHL Plus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Academic Search Premier, Health Source Nursing/Academic Edition and seven other databases was conducted.


METHODS
Studies were critically appraised by two independent reviewers using the Joanna Briggs Institute's standardised critical appraisal tool.


METHODS
Data were extracted using the standardised Joanna Briggs Institute's data extraction instruments.


RESULTS
Statistical pooling in meta-analysis was not appropriate. Findings are presented in a narrative form.


RESULTS
Three articles were included in the review, two RCTs and one pseudo-randomised controlled clinical trial. Structured discharge process did not have a positive impact in reducing hospital readmission at 30, 90, and 180 days and in reducing emergency room visit at 30 days. The outcome measure of unscheduled visit to healthcare provider was not measured in any of the three studies. The incorporation of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist were effective strategies in reducing hospital readmission in all three studies and in reducing emergency room visits in one of the studies.


CONCLUSIONS
Medication reconciliation with the addition of follow-up telephone calls and incorporation of either an advanced practice nurse, care coordinator, or a clinical pharmacist using a multidisciplinary team approach may have implications in existing coordination of care of adult patients with community acquired pneumonia.This review recommends use of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist as part of the structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.Further research is needed in examining the effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.
1. Pace University, New York, NY 2. Pace University, New York, NY; New Jersey Center for Evidence Based Practice at the University of Medicine and Dentistry of New Jersey (UMDNJ) a collaborating centre of the Joanna Briggs Institute.
Grace Rita R
GR
Domingo
Flordelis C
FC
Reyes
Fay V
FV
Thompson
Pauline M
PM
Johnson
Lillie M
LM
Shortridge-Baggett