This is not the most recent version of the article. View current version (20 JAN 2010)
Intervention Review
Discharge planning from hospital to home
Editorial Group: Cochrane Effective Practice and Organisation of Care Group
Published Online: 7 OCT 2009
Assessed as up-to-date: 24 SEP 2003
DOI: 10.1002/14651858.CD000313.pub2
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Shepperd S, Parkes J, McClaran JJM, Phillips C. Discharge planning from hospital to home. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD000313. DOI: 10.1002/14651858.CD000313.pub2.
Publication History
- Publication Status: Unchanged
- Published Online: 7 OCT 2009
This is not the most recent version of the article.View current version (20 Jan 2010)
Abstract
Background
Discharge planning is a routine feature of health systems in many countries. The aim is to reduce hospital length of stay and unplanned readmission to hospital, and improve the co ordination of services following discharge from hospital thereby bridging the gap between hospital and place of discharge. Sometimes discharge planning is offered as part of an integrated package of care, which may cover both the hospital and community. The focus of this review is discharge planning that occurs while a patient is in hospital; we exclude studies that evaluate dischage planning with follow up care.
Objectives
To determine the effectiveness of planning the discharge of patients moving from hospital.
Search strategy
Relevant studies were identified using Medline, Embase, SIGLE database for grey literature, Bioethics database, Health Plan, Psych. Lit, Sociofile, CINAHL, Cochrane Library, Econ Lit, Social Science Citation Index, EPOC register. The review was updated using the EPOC trials register in August 2002.
Selection criteria
Study design: randomised controlled trials (RCTs) that compare discharge planning (the development of an individualised discharge plan) with routine discharge care. Participants: all patients in hospital. Intervention: the development of an individualised discharge plan.
Data collection and analysis
Data analysis and quality assessment was undertaken independently by two reviewers using a data checklist. Studies are grouped according to patient group (elderly medical patients, surgical patients, and those with a mix of conditions), and by outcome.
Main results
Three new studies were included in this update. In total we included eleven RCTS: 6 trials recruited patients with a medical condition (2,368 patients), and four recruited patients with a mix of medical and surgical conditions (2,983 patients), one of these four recruited medical and surgical patients as separate groups, and the final trial recruited 97 patients in a psychiatric hospital and from a general hospital. We failed to detect a difference between groups in mortality for elderly patients with a medical condition (OR 1.44 95% CI 0.82 to 2.51), hospital length of stay (weighted mean difference -0.86, 95% CI -1.9 to 0.18), readmission rates (OR 0.91 95% CI 0.67 to 1.23) and being discharged from hospital to home (OR 1.15 95% CI 0.72 to 1.82). This was also the case for trials recruiting patients recovering from surgery and those recruiting patients with a mix of medical and surgical conditions. One trial comparing a structured care pathway for patients recovering from a stroke with multidisciplinary care reported a significant rate of improvement in functional ability and quality of life for the control group (median change in Barthel score between 4 to 12 weeks of 2 points for the treatment group, versus 6 for the control group, p<0.01); (Euroqol scores at 6 months 63 for the treatment group, vs. 72 for the control group, p<0.005). Two trials reported that patients with medical conditions allocated to discharge planning reported increased satisfaction compared with those who received routine discharge. No statistically significant differences were reported for overall health care costs.
Authors' conclusions
The impact of discharge planning on readmission rates, hospital length of stay, health outcomes and cost is uncertain. This reflects a lack of power as the degree to which we could pool data was restricted by the different reported measures of outcome. It is possible that even a small reduction in length of stay, or readmission rate, could have an impact on the timeliness of subsequent admissions in a system where there is an shortage of acute hospital beds.
Plain language summary
The impact of discharge planning on readmission rates, hospital length of stay, health outcomes, and cost to patients and health care providers is uncertain.
Discharge planning is the development of a discharge plan for the patient prior to leaving hospital, with the aim of containing costs and improving patient outcomes. The development of a discharge plan is increasingly becoming part of an integrated package of care, making it difficult to study the effects of discharge planning alone. Although the impact of discharge planning may be small, it is possible that even a small reduction in length of stay or readmission rate could free up capacity for subsequent admissions in a health care system where there is a shortage of acute hospital beds.