Effectiveness of nurse-led early discharge planning programmes for hospital inpatients with chronic disease or rehabilitation needs: a systematic review and meta-analysis

Aims and objectives: To compare the effectiveness of nurse-led early discharge planning programmes to standard care for inpatients with chronic disease or rehabilitation needs.

Background: Nurse-directed early discharge planning could shorten inpatient stays and reduce medical costs; however, it is not known whether the development of discharge planning programmes is effective for inpatients with chronic disease nor how such programmes might be optimally organised.

Design: Systematic review and meta-analysis.

Methods: The PubMed, MEDLINE, EMBASE, CINAHL and Cochrane Library were searched for randomized controlled trials assessing nurse-directed discharge planning for inpatients with chronic disease or rehabilitation needs. Two reviewers independently extracted data and assessed risk of bias. Meta-analyses were conducted for the eligible studies by RevMan 5.2.6. Data were pooled using a fixed-effect or random effects model. Where meta-analysis was not possible, narrative analysis was reported.

Results: Ten randomized controlled trials and 3438 participants were included. Meta-analysis demonstrated that, compared to standard care, early discharge planning programmes are effective in reducing hospital readmission rates, duration of inpatient readmissions and all-cause mortality. However, no reduction in the length of stay of the index admission was demonstrated. Narrative analysis suggested that discharge planning may reduce total and readmission costs, as well as improving patients' satisfaction and overall quality of life.

Conclusions: Compared to standard care, nurse-led early discharge planning programmes have a positive impact on several aspects of care for inpatients with chronic disease and rehabilitation requirements, including reducing readmission, readmission length of stay and mortality and improving quality of life. These findings should be taken into account in future health service policy development.

Relevance to clinical practice: These findings are relevant to clinical and managerial staff in formulating and implementing discharge planning programmes for inpatients with chronic disease or rehabilitation needs.