Effect of ED-based transitional care interventions by healthcare professionals providing transitional care in the emergency department on clinical, process and service use outcomes: a systematic review

Broek, Steef van den; Westert, Gert P.; Hesselink, Gijs; Schoon, Yvonne

doi:10.1136/bmjopen-2022-066030

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…This study is consistent with a previous finding that ED-based transitional care interventions by healthcare professionals were associated with a significant decrease in ED visits. 18 We promoted coordination and continuity of care during the transition between providers, patients and families, and a personalized medical action plan was created via mobile application. A COPD pamphlet that explains how to use the green/yellow/red selfassessment and monitoring to monitor the early indications of an imminent exacerbation was given to family caregivers of OAW-COPD.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review found that studying the effectiveness of transitional care interventions can help optimize the transition of care for older ED patients and reduce the risk of costly and potentially harmful readmissions for this population. 18 In addition, symptom management programs significantly reduce dyspnea symptoms and anxiety among OAW-COPD. 19…”

Section: Vol 28 Nomentioning

confidence: 99%

“…The total score ranges from 1-30, with a higher score indicating higher feasibility. The total feasibility score was divided into three levels: low (1-10), moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and high (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). An example of a question for the participant is, "Do you think the application is very suitable and feasible to use?"…”

Section: Pacific Rim Int J Nurs Res • January-march 2024mentioning

confidence: 99%

“…The total score ranges from 1-50, with a higher score indicating higher satisfaction. The level of satisfaction of utilizing the program can be divided into five levels: lowest (1-10), low (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), moderate (20-30), high (30-40), and highest (40-50). A question example is, "Could you rate the overall satisfaction with the application."…”

Section: Pacific Rim Int J Nurs Res • January-march 2024mentioning

confidence: 99%

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Transitional Care Based e-Health Program for Older Muslim Thai Adults with Chronic Obstructive Pulmonary Disease After Hospital Discharge: A Feasibility Study

Jehloh,

Kitrungrote,

Songwathana

2023

PRIJNR

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Older adults with chronic obstructive pulmonary disease frequently visit the emergency department due to an acute exacerbation of the disease or symptoms after discharge from hospital. Therefore, providing programs that enable caregivers to recognize and manage alert signs and symptoms in caring for older adults with chronic obstructive pulmonary disease at home is essential. This feasibility study is a part of emergency health management in transitional care program to reduce emergency department visits in older adults with dyspnea, and aimed to develop and test the Transitional Care Based e-Health Program. The program was tested using one group pre-test and post-test design with 50 family caregivers of older adults living with chronic obstructive pulmonary disease. Data was collected from November 2021 to May 2022. The ability to manage dyspnea symptoms among family caregivers and patient emergency department visits was assessed 30 days after hospital discharge. Data were analyzed using the Wilcoxon Signed Rank Test to compare the pre- and post-score differences. After implementation, it was found that the program was feasible and could improve the ability to manage dyspnea. Only three of 50 cases had emergency department visits within 30 days after discharge, accounting for 6% compared to the earlier report of 27.18%. The findings provide potential transitional care based on an e-health program to enhance the ability of dyspnea symptom management among family caregivers. Nurses can use this program in practice. However, further study is needed with randomized controlled trials before it can be widely used nationally.

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Section: Discussionmentioning

confidence: 99%

Section: Vol 28 Nomentioning

confidence: 99%

Section: Pacific Rim Int J Nurs Res • January-march 2024mentioning

confidence: 99%

Section: Pacific Rim Int J Nurs Res • January-march 2024mentioning

confidence: 99%

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Transitional Care Based e-Health Program for Older Muslim Thai Adults with Chronic Obstructive Pulmonary Disease After Hospital Discharge: A Feasibility Study

Jehloh,

Kitrungrote,

Songwathana

2023

PRIJNR

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“…Transitional care encompasses a broad range of services including comprehensive assessment, patient and family education, staff handover and communication, medication reconciliation, and development of a care management plan [12,13]. Two types of ED-based transitional care interventions were identified in a recent systematic review [14]. The first intervention type (individual needs assessment) comprised a structured comprehensive assessment of patient's individual needs and care and addressing these through site specific or outpatient resources.…”

Section: Introductionmentioning

confidence: 99%

Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis

Condon,

Griffin,

Fitzgerald

et al. 2024

BMC Geriatr

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Aim Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults’ experiences of transition to the community from the ED. Methods Six databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise findings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990). Findings Ten studies were included, and synthesis led to the development of five themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult’s ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance. Discussion/ conclusion Key areas for consideration in future service and intervention development are identified in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults’ changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life.

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Nurse Telephone Support for Caregivers of Older Adults at Hospital Discharge

Hill,

Moyle,

Slatyer

et al. 2024

JAMA Netw Open

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ImportanceInformal caregivers who provide home-based care frequently experience stress and burden that adversely affect their health-related quality of life (HRQOL).ObjectiveTo evaluate the efficacy of the Further Enabling Care at Home (FECH+) program for the HRQOL of caregivers of older adults discharged home from the hospital.Design, Setting, and ParticipantsThis multicenter, parallel, 2-group randomized clinical trial, with blinded baseline and outcome measurements, was conducted at 3 hospitals in 2 states in Australia. Recruitment took place between August 2020 and July 2022, and follow-up was performed for 12 months after hospital discharge. Participants were dyads of caregivers and patients. Eligible caregivers were aged 18 years or older who provided informal home-based care at least weekly for a patient aged 70 years or older. Caregivers were enrolled when their patient was discharged from the hospital. Dyads were randomly assigned to either the intervention or control group. Data analysis followed an intention-to-treat approach.InterventionCaregivers in the intervention group received the FECH+ program, structured nurse support of 6 telephone calls over 6 months after the patient’s discharge plus usual discharge care. Caregivers in the control group received usual care alone.Main Outcomes and MeasuresPrimary outcome was caregivers’ HRQOL 6 months after discharge, which was measured using the Assessment of Quality of Life 8-Dimension (AQOL-8D). Secondary outcomes were caregivers’ HRQOL 12 months after discharge as well as preparedness to care (measured using the Preparedness for Caregiving Scale), self-efficacy (measured using the Caregiver Inventory), and levels of strain and distress (measured using the Family Appraisal of Caregiving Questionnaire) at 6 and 12 months after discharge. Baseline and outcome measurements were administered by telephone at 3, 6, and 12 months after discharge.ResultsA total of 547 dyads (caregivers: 405 females [74.0%], mean [SD] age, 64.50 [12.82] years; patients: 296 females [54.1%], mean [SD] age, 83.16 [7.04] years for the intervention group and 83.45 [7.20] years for the control group) were included in the intention-to-treat analysis. There was no significant difference in caregivers’ HRQOL between the 2 groups at the primary time point of 6 months (difference in AQOL-8D score, 0.01; 95% CI, −0.02 to 0.03; P = .62) after hospital discharge.Conclusions and RelevanceIn this randomized clinical trial, the FECH+ program—a nurse telephone support intervention for caregivers of older adults after hospital discharge—did not significantly improve caregivers’ HRQOL at 6 months after discharge compared with usual care. Additional examination is warranted into improving caregivers’ HRQOL at the time of their patient’s hospital discharge.Trial RegistrationAustralian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943

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Effect of ED-based transitional care interventions by healthcare professionals providing transitional care in the emergency department on clinical, process and service use outcomes: a systematic review

Cited by 10 publications

References 28 publications

Transitional Care Based e-Health Program for Older Muslim Thai Adults with Chronic Obstructive Pulmonary Disease After Hospital Discharge: A Feasibility Study

Transitional Care Based e-Health Program for Older Muslim Thai Adults with Chronic Obstructive Pulmonary Disease After Hospital Discharge: A Feasibility Study

Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis

Nurse Telephone Support for Caregivers of Older Adults at Hospital Discharge

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