Patient Care

Discharge Planning Reduces Length of Stay in Elderly Patients Admitted with Medical Illnesses


 

Clinical question: Does discharge planning improve length of stay and reduce readmission rates compared to usual care?

Background: Discharge planning is accomplished to varying degrees for patients admitted to an acute-care hospital. Goals include improving the quality of care transitions as well as cost containment.

Study design: Meta-analysis.

Setting: Thirty studies that examined the effects of discharge planning.

Synopsis: In 12 studies focusing on older patients, discharge planning resulted in a reduction in hospital length of stay by 0.73 days (95% CI, -1.33 to -0.12). Readmission rates for this population were reduced, with approximately three fewer readmissions per 100 patients (relative risk, 0.87; 95% CI, 0.79–0.97). These results were not consistent for other populations, including surgical patients and patients admitted following a fall. No conclusions could be drawn on other outcomes, including patient and provider satisfaction, location of eventual discharge, and mortality. The effect of discharge planning on cost of care was uncertain based on the five trials reporting varied outcomes. Limitations include the varied descriptions of what constituted discharge planning and the lack of reporting on the role of communication in the process. Given the Centers for Medicare & Medicaid Services’ requirements for discharge planning, it is difficult to estimate the effect this study has on clinical practice.

Further study is needed to determine which aspects of discharge planning lead to desired clinical outcomes and the effects on overall cost of care.

Bottom line: Discharge planning in older patients with medical admissions appears to marginally reduce length of stay and readmission rates without a clear effect on cost of care.

Citation: Gonçalves-Bradley DC, Lannin NA, Clemson LM, Cameron ID, Shepperd S. Discharge planning from hospital. Cochrane Database Syst Rev. 2016;1:CD000313. doi:10.1002/14651858.CD000313.pub5.

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