BMC Geriatrics
Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: a systematic review and meta-analysis
Deborah Tregunno2  Kelly O’Brien3  Dina Brooks3  Ilo Maimets1  Malini Persaud2  Mary T Fox2 
[1]Steacie Science and Engineering Library, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada
[2]School of Nursing, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada
[3]Department of Physical Therapy and Graduate Department of Rehabilitation Sciences, University of Toronto, 27 Kings College Circle, Toronto, Ontario M5S 1A1, Canada
关键词: Meta-analysis;    Systematic review;    Patient discharge;    Hospital readmission;    Length of stay;    Aged;    Discharge planning;   
Others  :  857555
DOI  :  10.1186/1471-2318-13-70
 received in 2013-04-02, accepted in 2013-06-28, published in 13
【 摘 要 】


Older age and higher acuity are associated with prolonged hospital stays and hospital readmissions. Early discharge planning may reduce lengths of hospital stay and hospital readmissions; however, its effectiveness with acutely admitted older adults is unclear.


In this systematic review, we compared the effectiveness of early discharge planning to usual care in reducing index length of hospital stay, hospital readmissions, readmission length of hospital stay, and mortality; and increasing satisfaction with discharge planning and quality of life for older adults admitted to hospital with an acute illness or injury.

We searched the Cochrane Library, DARE, HTA, NHSEED, ACP, MEDLINE, EMBASE, CINAHL, Proquest Dissertations and Theses, PubMed, Web of Science, SciSearch, PEDro, Sigma Theta Tau International’s registry of nursing research, Joanna Briggs Institute, CRISP, OT Seeker, and several internet search engines. Hand-searching was conducted in four gerontological journals and references of all included studies and previous systematic reviews. Two reviewers independently extracted data and assessed risk of bias. Data were pooled using a random-effects meta-analysis. Where meta-analysis was not possible, narrative analysis was performed.


Nine trials with a total of 1736 participants were included. Compared to usual care, early discharge planning was associated with fewer hospital readmissions within one to twelve months of index hospital discharge [risk ratio (RR) = 0.78, 95% CI = 0.69 − 0.90]; and lower readmission lengths of hospital stay within three to twelve months of index hospital discharge [weighted mean difference (WMD) = −2.47, 95% confidence intervals (CI) = −4.13 − −0.81)]. No differences were found in index length of hospital stay, mortality or satisfaction with discharge planning. Narrative analysis of four studies indicated that early discharge planning was associated with greater overall quality of life and the general health domain of quality of life two weeks after index hospital discharge.


Early discharge planning with acutely admitted older adults improves system level outcomes after index hospital discharge. Service providers can use these findings to design and implement early discharge planning for older adults admitted to hospital with an acute illness or injury.

【 授权许可】

2013 Fox et al.; licensee BioMed Central Ltd.

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