Effectiveness of nurse-led transitional care interventions for adult patients discharged from acute care hospitals: a systematic review and meta-analysis.

Abstract

Background: With the guidance of healthcare policy and advances in medical technology, the average length of stay in hospitals continues to decrease. In this context, expectations for nurse-led interventions for patients discharged home are increasing. However, few systematic reviews of nurse-led transitional care have focused on patients discharged from acute care hospitals. This systematic review aimed to assess the effects of nurse-led transitional care interventions on readmission rates, unscheduled outpatient-visit rates, and quality of life (QOL) of adult patients discharged from acute care hospitals, compared with usual care.

Methods: Four electronic databases were searched for articles published through October 2023. Individual and cluster randomized controlled trials (RCTs) examining the effectiveness of nurse-led transitional care interventions were included. Independent reviewers performed study selection, data extraction, risk of bias assessment, and certainty of evidence using the GRADE approach.

Results: Sixteen RCTs were included. In a meta-analysis of RCTs with readmission rates as the outcome, readmission rates were significantly reduced in the intervention group when the data collection period exceeded 12 weeks (RR 0.67; 95% CI, 0.49-0.92; P = 0.01; I² = 66%; certainty: moderate). The rate of emergency room visits was also significantly reduced in the intervention group (RR 0.63; 95% CI, 0.49-0.81; P = 0.0003; I² = 0%; certainty: high). QOL measured with the SF-36 was significantly higher after 5 weeks (MD 1.27; 95% CI, 0.52-2.02; P = 0.0009, I² = 0%; certainty: low) and after 6 weeks (MD 2.46; 95% CI, 1.67-3.25; P = 0.00001; I² = 19%; certainty: low), both showing a possibility of improvement in the intervention group. However, the number of studies and samples included in the meta-analysis, particularly for readmission rates and QOL, were small, and the results should be interpreted with caution due to differences in subjects, institutions, and types of interventions.

Conclusion: Nurse-led transitional care interventions effectively reduced readmission and emergency department visit rates and improved QOL in adult patients discharged from acute care hospitals.