This review investigated whether discharge planning improved the appropriate use of acute care and patient outcomes. It also aimed to discover the impact on overall healthcare costs
Deborah Kesterson is clinical nurse specialist, Louis Stokes Cleveland VAMC, Cleveland, US, and a member of the Cochrane Nursing Care Field; Cindy Stern is administrator, Cochrane Nursing Care Field, faculty of health sciences, University of Adelaide, Australia.
This Cochrane review explored the following questions:
- Does discharge planning improve the appropriate use of acute care?
- Does discharge planning improve or, at least, have no adverse effect on patient outcome?
- Does discharge planning reduce overall costs of healthcare?
Discharge planning is a widespread process - nurses are frequently involved in planning and coordinating discharge. Discharge planning aims to decrease time spent in hospital, improve patient outcomes and reduce costs.
The evidence is not clear over whether discharge planning reduces costs or shifts them from secondary to primary care. Further research is needed to determine if discharge planning reduces readmission rates.
A total of 21 randomised controlled studies were included in this review, 10 of which were incorporated into the most recent update of the review.
Participants were hospital inpatients, and there were no restrictions on age or condition (n=7,234). Studies recruited patients with a medical condition (14 studies, 4,509 patients), patients from a psychiatric hospital (one study, 343 patients) and patients from both a psychiatric and general hospital (one study, 97 patients). Studies also featured patients admitted to hospital following a fall (one study, 60 patients) and patients from a mix of medical and surgical conditions (four studies, 2,225 patients).
The intervention of interest was an individualised discharge plan that was developed before the patient left hospital. All interventions included assessment, planning, implementation and monitoring components.
Interventions were compared to routine care – non-structured, individualised discharge planning - which varied between studies.
Outcomes of interest were length of hospital stay, readmission, complications, place of discharge, mortality, health status, patient and carer satisfaction, psychological health of patient and carer, cost of discharge planning (to hospital and community) and, where applicable, medication use. Follow-up was carried out between two and 36 weeks.
The following studies were excluded: those that used discharge planning as part of a larger package of care that was not well described; that did not include an assessment and implementation phase of discharge planning; and that did not separate the effects of discharge planning from other components. Other studies excluded were those where discharge planning was a small part of a multifaceted intervention, and that focused on the provision of care post discharge.
Just over half of all included studies reported there had been adequate allocation concealment, and 15 described blinding of outcomes. Meta-analysis was undertaken where possible.
Summary of key evidence
- Results from 10 pooled studies indicated that the intervention group (discharge planning) was associated with a significant shorter length of hospital length that the usual care group (P=0.0052).
- Pooled data from 11 studies showed that hospital readmission rates were significantly lower when discharge planning was used compared with usual care in people admitted for a medical condition (P=0.013).
- There were no statistically significant differences in mortality between intervention and control groups in the following populations: elderly patients with a medical condition (four studies); patients recovering from surgery; patients admitted to hospital following a fall (one trial), and those with a mix of medical and surgical conditions (one trial).
- There was no significant difference in place of discharge (three trials) and patient outcomes (10 trials) between intervention and control groups.
- There were mixed results regarding patient satisfaction in three studies that could not be pooled and five studies for cost.
Best practice recommendations
- Current evidence suggests that structured discharge planning probably brings a small reduction in length of stay and readmission rates for older people admitted to hospital with a medical condition.
- Discharge planning does not seem to have an impact on mortality, health outcomes and healthcare costs and further research is required.
Shephard S et al (2010) Discharge planning from the hospital to home. Cochrane Database of Systematic Reviews; Issue 1 Art No: CD000313. DOI: 10.1002/14651858.CD000313.pub3.
The full review report, including references, can be accessed at click here