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Open AccessReview

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

1
Department of Nursing and Midwifery, Health Sciences Building, University of Limerick, Limerick V94X5K6, Ireland
2
School of Nursing and Midwifery, University College Cork, Cork City T12AK54, Ireland
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Nursing and Vice Dean of Graduate Studies and Inter Professional Learning, College of Medicine and Health, University College Cork, Cork City T12AK54, Ireland
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School of Pharmacy, University College Cork, Cork City T12T656, Ireland
5
Geriatric Medicine, Mercy University Hospital, Cork City T12WE28, Ireland
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Clinical Sciences Institute, National University of Ireland, and Portiuncula University Hospital, Ballinasloe Galway H53T971, Ireland
7
Clinical Sciences Institute, National University of Ireland, Galway City, Mercy University Hospital, Grenville Place, Cork City T12WE28, Ireland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(14), 2457; https://doi.org/10.3390/ijerph16142457
Received: 15 May 2019 / Revised: 29 June 2019 / Accepted: 5 July 2019 / Published: 10 July 2019
(This article belongs to the Special Issue Efficient Use of Acute Hospital Services for Older People)
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Abstract

Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up. View Full-Text
Keywords: discharge; admission; primary care; length of stay; transition; intermediate care; homecare; model; intervention; hospital avoidance discharge; admission; primary care; length of stay; transition; intermediate care; homecare; model; intervention; hospital avoidance
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Coffey, A.; Leahy-Warren, P.; Savage, E.; Hegarty, J.; Cornally, N.; Day, M.R.; Sahm, L.; O’Connor, K.; O’Doherty, J.; Liew, A.; Sezgin, D.; O’Caoimh, R. Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review. Int. J. Environ. Res. Public Health 2019, 16, 2457.

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