Neil H. Winawer, MD, SFHM

A nurse-led, in-hospital discharge intervention among higher-risk older patients failed to prevent readmissions or emergency department visits.

Implementation of discharge support programs to prevent hospital readmissions has yielded mixed results. Recent meta-analyses of such programs have suggested that multicomponent interventions at the healthcare systems level are required to influence care outcomes (NEJM JW Hosp Med Sep 17 2012). Individual components that lead to better outcomes have yet to be elucidated.

Researchers randomized 700 older, low-income, ethnically diverse patients (mean age, 66) at a single safety net hospital to usual care or to a nurse-led, in-hospital, discharge support intervention. Usual-care patients received registered nurse (RN) reviews of discharge instructions and, if indicated, pharmacy or social-worker consultations. Intervention patients received usual care plus language-concordant RN coaching and teach-back techniques (on symptom recognition, medication reconciliation, and strategies to navigate the health system) at enrollment and discharge. Additionally, primary care physicians of intervention patients were notified of inpatient providers' contact information, and nurse practitioners called patients at home on days 1–3 and 6–10 after discharge. Despite these interventions, the primary outcome of emergency department visits or readmissions did not differ between the groups at 30, 60, or 180 days.

Citation(s):

Goldman LE et al. Support from hospital to home for elders: A randomized trial. Ann Intern Med 2014 Oct 7; 161:472.