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Effectiveness of nursing discharge planning interventions on health-related outcomes in elderly inpatients discharged home: a systematic review protocol

Cedric Mabire, Stefanie Monod, Andrew Dwyer, Joanie Pellet


Review question/objective

The aim of this systematic review is to determine the best available evidence of the effectiveness of discharge planning interventions involving at least one nurse on health related outcomes, including, but not limited to, functional limitations, symptom management, unmet needs and/or health related quality of life for elderly inpatients discharged home. Furthermore, the objective of this study is to assess the relative impact of individual components of discharge planning interventions

Inclusion criteria

Types of participants

This review will consider studies that included elderly inpatients, aged 65 years or older, discharged from acute care and post-acute care rehabilitation hospitals (including skilled nursing home facilities) to home.

Types of intervention(s)/phenomena of interest

This review will consider studies that assess the following nursing discharge planning interventions:

1.         Early geriatric assessment

2.         Discharge preparation: education/teaching medication self-management, developing self-care management skills, symptoms management, effective communication and information about discharge plan, effective multidisciplinary communication

3.         Patient or caregivers participation/involvement to the discharge planning and decision making related to discharge destination

4.         Continuity of care (coordination and effective communication between hospital staff, primary care and health care providers, coordination of the patient’s discharge/transitional plan, management of patient’s transition and post discharge needs

5.         Day of discharge assessment regarding discharge planning (medication reconciliation, completion and explanation to the patient of the discharge summary) and

6.         Post discharge follow-up (home care follow up/visits, follow-up phone calls).

This systematic review will focus on discharge planning interventions: i) provided by at least one nurse; and ii) which are incorporated into a multidisciplinary and/or interdisciplinary model of care.

Types of outcomes

This review will consider studies that include the following outcome measures:

1.)   Functional ability/functional limitations

2.)   Symptoms/medical condition management/adverse outcomes

3.)   Unmet needs after hospital discharge

4.)   Coping with disease /coping difficulties

5.)   Health related quality of life

6.)   Satisfaction with care during the discharge planning process

7.)   Health care utilization (eg number of hospital visits).


aged; discharge planning; health related outcomes; nursing interventions; transitional care

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