Effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia: A systematic review.

BACKGROUND: Hospital readmission soon after discharge is common and costly. To date, published studies of effectiveness of structured discharge process addressing reduction of hospital readmission have focused on patients with chronic conditions and complex needs, but not in adult patients with community acquired pneumonia.

OBJECTIVES: To examine and synthesise the best available evidence related to effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.

INCLUSION CRITERIA: This review considered studies that included hospitalised adult patients diagnosed with community acquired pneumonia regardless of gender, ethnicity, severity, and co-morbidities.Structured discharge process related to early patient engagement, patient-caregiver dyad intervention, transitional care, coordinated care, and multidisciplinary team approach.The outcome measures included in this review were hospital readmission, emergency room visits, and unscheduled visits to healthcare provider.Randomised controlled trials (RCTs) and quasi-experimental studies were considered for inclusion.

SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies in English language without date limits. A search of PubMed/MEDLINE, CINAHL, CINAHL Plus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Academic Search Premier, Health Source Nursing/Academic Edition and seven other databases was conducted.

METHODOLOGICAL QUALITY: Studies were critically appraised by two independent reviewers using the Joanna Briggs Institute's standardised critical appraisal tool.

DATA EXTRACTION: Data were extracted using the standardised Joanna Briggs Institute's data extraction instruments.

DATA SYNTHESIS: Statistical pooling in meta-analysis was not appropriate. Findings are presented in a narrative form.

RESULTS: Three articles were included in the review, two RCTs and one pseudo-randomised controlled clinical trial. Structured discharge process did not have a positive impact in reducing hospital readmission at 30, 90, and 180 days and in reducing emergency room visit at 30 days. The outcome measure of unscheduled visit to healthcare provider was not measured in any of the three studies. The incorporation of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist were effective strategies in reducing hospital readmission in all three studies and in reducing emergency room visits in one of the studies.

CONCLUSIONS: Medication reconciliation with the addition of follow-up telephone calls and incorporation of either an advanced practice nurse, care coordinator, or a clinical pharmacist using a multidisciplinary team approach may have implications in existing coordination of care of adult patients with community acquired pneumonia.This review recommends use of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist as part of the structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.Further research is needed in examining the effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.