Background: Reducing unplanned readmission is one of the most important issues to prevent unnecessary medical costs. Although various nurse-led discharge care programs have been implemented to reduce rehospitalization, there is a lack of evidence of effectiveness of the interventions.
Objectives: This study is to identify the effectiveness of a nurse-led discharge program on unplanned readmission in patients at home.
Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL were used to search for randomized controlled trials (RCT) with ‘nurse-led discharge program’ and ‘unplanned readmission’, published in English between 2005 and 2014. Two reviewers performed critical appraisal of the retrieved studies using Cochrane's tool for assessing risk of bias. Data were analyzed using Review Manager (Revman) software 5.2.
Results: Ten studies were analyzed. (five studies were in heart failure, two in colorectal cancer, two in various diagnoses, and one in stroke patients). The main components of nurse-led discharge care programs were care planning, patient education, home visits and telephone visits. Among the ten studies, three studies measured unplanned readmission at 30 days while others were at various time points. These three studies were included in a meta-analysis. The bias most often identified in the included studies was performance bias: blinding of participant and personnel was not found in eight studies (Figure 1). The odds ratio (OR) of 30 day unplanned readmission for a nurse-led discharge program versus usual care was 0.71 (95% confidence interval 0.53 to 0.95; P = 0.02). I2 score was 0% which means the analyzed studies were homogeneous (Fig 2).
Conclusions: The results indicate that nurse-led discharge programs are effective and produce a 29% reduction in unplanned readmissions. However, few studies were included in the analysis and blinding of participants and personnel was at high risk of bias. Therefore, we suggest well-designed RCTs should be conducted in this area.