154 SYSTEMATIC REVIEW OF LITERATURE OF SYSTEMS AND MODELS TO ADDRESS HOSPITAL READMISSION AVOIDANCE AND DELAYED DISCHARGE

Background: Prolonged hospital admission and readmission lead to increased risk of adverse healthcare outcomes. A diverse spectrum of strategies have been proposed across multiple settings to address these patient important outcomes. We conducted a systematic review to identify successful systems and models addressing readmission avoidance and delayed discharge. Methods: We searched MEDLINE, CINAHL, PsychINFO, Psychology and Behavioural Sciences Collection, Social Sciences and SocINDEX with Full Text, limited to English language papers published between 2005–2015. Two authors independently assessed studies for inclusion and extracted data. Selected studies were those that explicitly addressed interventions in acute general hospitals. Results: In total, 85 eligible papers were identified: meta-review of meta-analyses (n = 1), systematic reviews with meta-analyses (n = 8), systematic reviews (n = 36), and RCTs (n = 40). A wide variety of interventions exist to address delayed discharge and readmissions. Interventions were classified as clinical/medical, pre-discharge, transitional care, post-discharge, primary care, assessment/ambulatory unit interventions, hospital at home, home-based interventions, tele-healthcare/electronic interventions, and residential care interventions. Educational interventions were the most common clinical/medical intervention but their effectiveness was limited. Transitional care interventions had a generally positive effect, particularly on delayed discharge but less so for older adults. Likewise, primary care, assessment/ambulatory unit and hospital at home/home-based strategies. Existing systematic reviews of pre and post-discharge, tele-healthcare/electronic and residential care interventions suggest that there is limited evidence that these significantly influence outcomes. Conclusion: Mixed results were found regarding the effectiveness of many types of interventions, which were heterogeneous between studies. The most effective interventions to tackle delayed discharge and readmission avoidance were those involving integrated systems across the hospital and community, multidisciplinary service provision, individualisation of services and hospital initiated discharge and follow-up by specialists.