The effectiveness of a discharge team in the transition from hospital to home

Abstract

Overview of the Topic: The period of hospitalisation is a time of increased vulnerability for elder adults, especially for those suffering in an already frail condition. Older patients face a higher risk of experiencing an adverse effect with lengthened hospital stay. Inadequate care delivery during previous hospitalisation leads to an increased incidence of readmissions. A percentage of readmissions are preventable with the implementation of a pre-discharge assessment and post-discharge care. The introduction of a discharge team is a cost-effective way to ensure patient safety throughout the discharge process. The Research Question: How effective is the introduction of a Discharge Team in the transition of care from hospital to home? PICO Elements: The population (P) consists of hospitalised patients aged over 60. The intervention (I) was the implementation of a discharge team while the comparison (C) was the usual care given to patients. The outcomes assessed were improvement in readmissions, length of stay, hospital costs and patient quality of life. Inclusion and Exclusion Criteria: Any patient aged 60 or over was included. Discharge interventions such as planning and multi-disciplinary teams were included while any intervention that did not focus on the discharge process was excluded. Usual care was the only comparison included. Search Outcome: Once the inclusion and exclusion criteria were applied, five articles were selected as eligible. These consisted of a meta-analysis, a meta-analysis and systemic review, a systemic review and two randomised controlled trials. Method: Keywords were derived from the formulated PICO elements. The chosen keywords combined with search tools and Boolean Operators were used in a systemic literature search in databases including EBSCO (CINAHL Complete), PubMed, ProQuest and HyDi. The PRISMA checklist along with the aforementioned inclusion and exclusion criteria eliminated any irrelevant articles and the remaining articles were assessed for eligibility. The literature chosen was critically appraised using the CASP Tool. Results: Five key studies were obtained. The meta-analysis failed to show statistically significant results while the meta-analysis and systemic review reported significant results for the outcomes of readmission and length of stay. The systemic review concluded with mixed findings. One RCT reported positive results for the outcomes of length of stay and patients’ quality of life with increased independence in ADL’s. The final RCT reported significant reductions in readmissions and emergency room visits. Conclusion: A definite conclusion could not be obtained from this dissertation, however findings reported improvement in readmissions and the evidence presented showed that a discharge intervention has a trend for improving the outcomes assessed in older patients. Further research is required to definitively answer the research question. Implications and Recommendations: To prevent readmissions and improve the transition from hospital to home a discharge intervention is advised. It is important to educate ward nurses on the assessment of patients prior to discharge to assess the need for further involvement. Healthcare workers must be educated on which patients face a higher risk of readmission and inadequate discharge. It is also advised to update guidelines and promote them to ward staff. Future research should focus on defining the comparison of usual care and assessing which population of older patients benefit more from a discharge intervention.