Meta‐analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home

Mabire, Cédric; Dwyer, Andrew A.; Garnier, Antoine; Pellet, Joanie

doi:10.1111/jan.13475

Cited by 49 publications

(64 citation statements)

References 64 publications

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“…Similarly, a systematic review in 2015 found ED community transition strategies had no positive effect on unplanned ED presentations (odds ratio 1.32, 95% CI 0.99–1.76), hospital admissions (odds ratio 0.89, 95% CI 0.65–1.21) and mortality (odds ratio 1.01, 95% CI 0.70–1.47) . Another systematic review with 13 studies found that nursing discharge planning neither reduces readmission rate nor improves quality of life . A systematic review of RCT also concluded that there was no single intervention prior or after discharge that was significantly associated with a reduction in 30‐day hospital readmission …”

Section: Discussionmentioning

confidence: 99%

“…23 Another systematic review with 13 studies found that nursing discharge planning neither reduces readmission rate nor improves quality of life. 24 A systematic review of RCT also concluded that there was no single intervention prior or after discharge that was significantly associated with a reduction in 30-day hospital readmission. 25 In contrast, a single-center RCT with 749 hospitalized adults found participants with a package of discharge services (including a nurse discharge advocate who arranged follow-up appointments and confirmed medication reconciliation with further postdischarge reinforcement with a clinical pharmacist) had a lower rate of ED visits or readmissions within 30 days of the discharge than usual care participants (incidence rate ratio 0.695, P = 0.009).…”

Section: Discussionmentioning

confidence: 99%

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Association between post‐discharge secondary care and risk of repeated hospital presentation, entry into long‐term care and mortality in older people after acute hospitalization

Kim

Broad

et al. 2019

Geriatrics Gerontology Int

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Aim Hospitalizations are frequent among acutely ill older people, and might be reduced by post‐discharge secondary care (PDSC). We aimed to determine the proportion of older patients planned to receive or attending PDSC after acute hospitalization and the association with undesirable outcomes. Methods A retrospective observational study was carried out using an electronic health record system in two hospitals in New Zealand. Patients were aged ≥75 years, initially presented at an emergency department (ED) and were discharged from medical, surgical, geriatrics or orthopedics wards in three 2‐week periods. Planned PDSC at discharge, attended PDSC, ED presentation, long‐term care (LTC) admission and death in 90 days after discharge were obtained through the health record system. Proportional hazards regression assessed the associations of planned or attended PDSC with undesirable outcomes (ED presentation, LTC admission and death) within 90 days of discharge. Results Clinical records for 1085 patients were extracted, 963 were eligible. Of these, 413 (42.9%) had planned PDSC in discharge summaries, and 573 (59.5%) actually attended in 90 days. Patients planned for PDSC had a similarly adjusted hazard of ED presentation (HR 0.99, P = 0.92), LTC admission (HR 0.73, P = 0.25) and death (HR 0.80, P = 0.34) within 90 days of discharge, compared with those not planned. Similar non‐significant associations were observed between attended PDSC and undesirable outcomes. Conclusions In patients aged ≥75 years in New Zealand, we did not find “planned PDSC” at discharge or “attended PDSC” after an acute hospitalization to be associated with ED presentation, LTC admission and death within 90 days after discharge. Other potential benefits of planned or attended PDSC require further investigation. Geriatr Gerontol Int 2019; 19: 1048–1053.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between post‐discharge secondary care and risk of repeated hospital presentation, entry into long‐term care and mortality in older people after acute hospitalization

Kim

Broad

et al. 2019

Geriatrics Gerontology Int

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“…A number of studies have addressed the effect of discharge planning, however, it might be mild on enhancing the quality of life in patients suffering from chronic diseases such as breast cancer and heart diseases (16,17). Based on the findings of a review meta-analysis, which examined the impact of discharge planning in old people, this method is effective in reducing the readmission rate of the elderly in America (15). However, conducting this program in the case of diabetic patients and exploring its impact on indicators, such as HBA1C, have received less attention.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Effect of Discharge Planning on Glycosylated Hemoglobin Level in Type 2 Diabetic Patients Who Referred to the Vasei Hospital in Sabzevar, Iran: An Interventional Study

2019

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Background: Diabetes mellitus is one of the most common chronic diseases that causes various complications. Glycosylated hemoglobin is a reliable indicator of diabetes. Objectives: The purpose of the present study was to assess the impact of discharge planning on improving glycosylated hemoglobin in patients with type 2 diabetes. Methods: This is a quasi-experimental study which was conducted in Vasei Hospital, Sabzevar, in 2014. The subjects of this study included 70 patients with type 2 diabetes who were chosen non-randomly through convenience sampling. The subjects were divided into the intervention and control groups. Results: The findings showed a significant difference between the control and intervention groups in terms of mean value of glycosylated hemoglobin obtained in the post-test (7.25 versus 8.16, P < 0.001). Controlling the effects of the pre-test, the authors observed similar results obtained via covariance analysis.

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“…It seems likely that the need for community nursing services will grow faster than the capacity of those services to meet that need unless attention is paid to both sides of the capacity / demand equation, and services are targeted to those individuals for whom it is most critical. Evidenced based approaches focussed on patient-centred outcomes are needed, but the right direction may not always be intuitive, such as a recent meta-analysis questioning the benefits of detailed discharge planning on patient health outcomes (Mabire et al, 2017). Evaluation of interventions is essential, therefore, to demonstrate safety and encourage wider adoption of practices found to be effective.…”

Section: Discussionmentioning

confidence: 99%

Post-cataract eye drops can be avoided by depot steroid injections

Cleveland

Sutton

Cassels-Brown

2017

Br J Community Nurs

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There are over 400,000 cataract operations now being performed annually in the UK. With the majority of those patients being elderly, co-morbidities such as dementia or arthritis can prevent patients putting in their own post-operative eye drops. Where there is a lack of family or other support, district nursing services are often called upon to administer these eye drops, which are typically prescribed four times a day for four weeks, thus potentially totalling 112 visits for drop instillation per patient.To reduce the burden of these post-operative eye drops on district nursing services, administration of an intra-operative sub-tenons depot steroid injection is possible for cataract patients who then do not require any post-operative drop instillation. As a trial of this practice, sixteen such patients were injected in one year, thus providing a reduction of 1792 in the number of visit requested. Taking an estimated cost of each district nurse visit of £38, this shift in practice potentially saved >£68,000; the additional cost of the injection over the cost of eye drops was just £8.80 for the year. This practice presents an opportunity to protect valuable community nursing resources, but advocacy for change in practice would be needed with secondary care, or via commissioners. Key WordsCataract, cataract surgery, ophthalmic solutions, community health nursing Key Points-Cataract surgery is the most common surgical intervention in the UK -With the ageing population, a growing number of patients are unable to instill their own eye drops post operatively and require district nursing support -A depot steroid injection intra-operatively removes the requirement for postoperative drops, thus permitting redeployment of valuable district nursing resources

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Meta‐analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home

Abstract: Nursing discharge planning is a complex intervention and difficult to evaluate. Findings suggest that nursing discharge planning for older inpatients discharged home increases the length of stay yet neither reduces readmission rate nor improves quality of life.

Cited by 49 publications

References 64 publications

Association between post‐discharge secondary care and risk of repeated hospital presentation, entry into long‐term care and mortality in older people after acute hospitalization

Association between post‐discharge secondary care and risk of repeated hospital presentation, entry into long‐term care and mortality in older people after acute hospitalization

Evaluating the Effect of Discharge Planning on Glycosylated Hemoglobin Level in Type 2 Diabetic Patients Who Referred to the Vasei Hospital in Sabzevar, Iran: An Interventional Study

Post-cataract eye drops can be avoided by depot steroid injections

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