Interventions to improve patient safety in transitional care – a review of the evidence

Abstract

When a patient's transition from the hospital to home is less than optimal, the repercussions can be far-reachinghospital readmission, adverse medical events, and even mortality. Elderly, especially frail older patients with complex health care problems appear to be a group particularly at risk for adverse events in general, and during transitions across health providers in particular. We undertook a systematic review to identify interventions designed to improve patient safety during transitional care of the elderly, with a particular focus on discharge interventions. We searched the literature for qualitative and quantitative studies on the subject published over the past ten years. The review revealed a set of potential intervention types aimed at the improvement of communication that contribute to safe transitional care. Intervention types included professionoriented interventions (e.g. education and training), organisational/culture interventions (e.g. transfer nurse, discharge protocol, discharge planning, medication reconciliation, standardized discharge letter, electronic tools), or patient and next of kin oriented interventions (e.g. patient awareness and empowerment, discharge support). Results strongly indicate that elderly discharged from hospital to the community will benefit from targeted interventions aimed to improve transfer across healthcare settings. Future interventions should take into account multi-component and multi-disciplinary interventions incorporating several single interventions combined.

Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital – a qualitative study of health professionals’ experiences

“…It also prepared for admission to primary health care, particularly by improving the patients’ condition, the provision of daily living aids and the required information. The intermediate care hospital's role as a discharge unit includes several features for successful discharge [24] and is in line with Morris [11] who stated that rapidly moving patients through the emergency system towards discharge is an approach that may benefit younger people at the expense of effective planning and comprehensive treatment for the frail and elderly.…”

“…Integrated discharge pathways for elderly patients can be achieved in various ways: Discharge arrangements range from hospital-based teams [19], care pathways across hospital and primary health care [20, 21], to interventions within primary health care to improve discharge support [22]. A combination of pre- and post-discharge interventions seems to be essential [23], as this recently has been pointed out among features of successful discharge interventions targeted at elderly patients [24]. Discharge coordinator, multidisciplinary approach, education, medical reconciliation and comprehensive transitional care programmes are other identified features of success [24].…”

“…A combination of pre- and post-discharge interventions seems to be essential [23], as this recently has been pointed out among features of successful discharge interventions targeted at elderly patients [24]. Discharge coordinator, multidisciplinary approach, education, medical reconciliation and comprehensive transitional care programmes are other identified features of success [24]. …”

Quality in transitional care of the elderly: Key challenges and relevant improvement measures

“…Both researchers conducted data collection simultaneously in the two case study sites, using a thematic observational guide adapted to admission and discharge transitions. The guide was based on extensive literature reviews [6, 19, 24] and covered the following themes: structures and plans, coordination with other care providers, interdisciplinary collaboration, documentation and information, coordination and communication with patient and next of kin, and context and improvement areas. Observational field notes were written consecutively during the observational period by the two researchers [22].…”

“…transfer nurse, discharge protocol, discharge planning, medication reconciliation, standardised discharge letter, electronic tools), or patient- and next-of-kin-oriented interventions (e.g. patient awareness and empowerment, discharge support) [19]. …”