Care Transtion in Hospital Discharge for Adult Patients: Integrative Literature Review

Abstract

Objective: to summarize and analyze the scientific production on care transition in the hospital discharge of adult patients. Method: integrative review, conducted from May to July 2020, in four relevant databases in the health area: Public Medline (PubMed); Scientific Electronic Library Online (SciELO); Scopus and Virtual Health Library (VHL). The analysis of the results occurred descriptively and was organized into thematic categories that emerged according to the similarity of the contents extracted from the articles. Results: 46 articles from national and international journals, with a predominance of descriptive/non-experimental studies or qualitative studies, met the inclusion criteria. Five categories were identified: discharge and post-discharge process; Continuity of post-discharge care; Benefits of care transition; Role of nurses in care transition and Experiences of patients on care transition. Hospital discharge and care transitions are interconnected processes as transitions qualify the dehospitalization process. Different strategies for continuity of care should be adopted, as they offer greater safety to the patient. Studies have shown that nurses play a fundamental role in transitions and, in Brazil, this activity still needs to gain more space. Reduced hospitalizations, mortality, hospital costs and patient satisfaction are benefits of transitions. Conclusion: care transition is an effective strategy for the care provided to the patient being discharged. It points out the need for integration between the care network and assists services in decision-making about the continuity of care on discharge.

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“…A transição de via, sob a perspectiva do paciente, agrega ainda a possibilidade do convívio familiar e da comunidade, do retorno precoce ao ambiente laboral, além da redução de riscos evitáveis oriundos do ambiente hospitalar (Silva et al, 2018). Sob a perspectiva da instituição de saúde, a diminuição do tempo de internação corrobora a redução de gastos, além de ser um dos indicadores de desempenho e de qualidade hospitalar (Gheno & Weis, 2021;Malley & Greenwald, 2020).…”

Development of a measurement instrument to assess patient safe transition at hospital discharge

“…Nurses play a pivotal role in care transitions, identifying patients' needs for post-discharge care, coordinating discharge planning, educating patients and families, communicating with health providers and other health services to ensure quality in patient healthcare trajectory (7,10) . The TranSPAH instrument could be used by nurses and institutions to identify strengths and weaknesses in care transitions and provide feedback for devising intervention proposals for nursing practice and management.…”

“…The following strategies have been used for better transitions: discharge planning, health education for the patients and promotion of self-management, safety in medication use, full communication of diverse information and post-discharge follow-up (9)(10) . Some hospitals in countries such as Canada, Spain and Portugal direct nurses to work exclusively in care transitions, with the function of improving communication and care coordination at hospital discharge (6) .…”

“…In Brazil, deployment of nurses or teams devoted to care transition is still emerging (6) . Often times, post-discharge continuity of care is hampered by the limitations in involvement of health teams, work overload, limited time spent on educating and guiding patients and their families, as well as unplanned discharges, difficulties scheduling appointments and lack of in-home monitoring (10)(11) .…”

Facilidades e desafios do processo de transição do cuidado na alta hospitalar

“…É um processo complexo que exige habilidades de coordenação e comunicação, pois envolve o paciente, os familiares, os cuidadores e os profissionais de saúde (1,2) . Estudos afirmam que realizar a transição do cuidado resulta em assistência à saúde de qualidade, contribuindo para redução das reinternações, dos óbitos, dos custos hospitalares e dos eventos adversos pósalta (2,3) .…”