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Meta-Analysis
. 2016 Jan 27;2016(1):CD000313.
doi: 10.1002/14651858.CD000313.pub5.

Discharge planning from hospital

Daniela C Gonçalves-Bradley  1 , Natasha A Lannin, Lindy M Clemson, Ian D Cameron, Sasha Shepperd
Affiliations
Meta-Analysis

Discharge planning from hospital

Daniela C Gonçalves-Bradley et al. Cochrane Database Syst Rev. .

Abstract

Background: Discharge planning is a routine feature of health systems in many countries. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and to improve the co-ordination of services following discharge from hospital.This is the third update of the original review.

Objectives: To assess the effectiveness of planning the discharge of individual patients moving from hospital.

Search methods: We updated the review using the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 9), MEDLINE, EMBASE, CINAHL, the Social Science Citation Index (last searched in October 2015), and the US National Institutes of Health trial register (ClinicalTrials.gov).

Selection criteria: Randomised controlled trials (RCTs) that compared an individualised discharge plan with routine discharge care that was not tailored to individual participants. Participants were hospital inpatients.

Data collection and analysis: Two authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies according to patient groups (elderly medical patients, patients recovering from surgery, and those with a mix of conditions) and by outcome. We performed our statistical analysis according to the intention-to-treat principle, calculating risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous data using fixed-effect meta-analysis. When combining outcome data was not possible because of differences in the reporting of outcomes, we summarised the reported data in the text.

Main results: We included 30 trials (11,964 participants), including six identified in this update. Twenty-one trials recruited older participants with a medical condition, five recruited participants with a mix of medical and surgical conditions, one recruited participants from a psychiatric hospital, one from both a psychiatric hospital and from a general hospital, and two trials recruited participants admitted to hospital following a fall. Hospital length of stay and readmissions to hospital were reduced for participants admitted to hospital with a medical diagnosis and who were allocated to discharge planning (length of stay MD - 0.73, 95% CI - 1.33 to - 0.12, 12 trials, moderate certainty evidence; readmission rates RR 0.87, 95% CI 0.79 to 0.97, 15 trials, moderate certainty evidence). It is uncertain whether discharge planning reduces readmission rates for patients admitted to hospital following a fall (RR 1.36, 95% CI 0.46 to 4.01, 2 trials, very low certainty evidence). For elderly patients with a medical condition, there was little or no difference between groups for mortality (RR 0.99, 95% CI 0.79 to 1.24, moderate certainty). There was also little evidence regarding mortality for participants recovering from surgery or who had a mix of medical and surgical conditions. Discharge planning may lead to increased satisfaction for patients and healthcare professionals (low certainty evidence, six trials). It is uncertain whether there is any difference in the cost of care when discharge planning is implemented with patients who have a medical condition (very low certainty evidence, five trials).

Authors' conclusions: A discharge plan tailored to the individual patient probably brings about a small reduction in hospital length of stay and reduces the risk of readmission to hospital at three months follow-up for older people with a medical condition. Discharge planning may lead to increased satisfaction with healthcare for patients and professionals. There is little evidence that discharge planning reduces costs to the health service.

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Conflict of interest statement

DCGB: none known. NL: none known. LC: none known. IC: none known. SS: none known.

Figures

1
1
PRISMA flow diagram
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Effect of discharge planning on hospital length of stay, Outcome 1 Hospital length of stay ‐ older patients with a medical condition.
1.2
1.2. Analysis
Comparison 1 Effect of discharge planning on hospital length of stay, Outcome 2 Sensitivity analysis imputing missing SD for Kennedy trial.
1.3
1.3. Analysis
Comparison 1 Effect of discharge planning on hospital length of stay, Outcome 3 Hospital length of stay ‐ older surgical patients.
1.4
1.4. Analysis
Comparison 1 Effect of discharge planning on hospital length of stay, Outcome 4 Hospital length of stay ‐ older medical and surgical patients.
2.1
2.1. Analysis
Comparison 2 Effect of discharge planning on unscheduled readmission rates, Outcome 1 Within 3 months of discharge from hospital.
4.1
4.1. Analysis
Comparison 4 Effect of discharge planning on patients' place of discharge, Outcome 1 Patients discharged from hospital to home.
4.4
4.4. Analysis
Comparison 4 Effect of discharge planning on patients' place of discharge, Outcome 4 Older patients admitted to hospital following a fall in residential care at 1 year.
5.1
5.1. Analysis
Comparison 5 Effect of discharge planning on mortality, Outcome 1 Mortality at 6 to 9 months.
6.4
6.4. Analysis
Comparison 6 Effect of discharge planning on patient health outcomes, Outcome 4 Falls at follow‐up: patients admitted to hospital following a fall.
8.5
8.5. Analysis
Comparison 8 Effect of discharge planning on hospital care costs, Outcome 5 Hospital outpatient department attendance.
8.6
8.6. Analysis
Comparison 8 Effect of discharge planning on hospital care costs, Outcome 6 First visits to the emergency room.
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References to ongoing studies

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References to other published versions of this review

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