University of California, San Francisco, San Francisco, California, USA.
Ann Intern Med. 2013 Mar 5;158(5 Pt 2):433-40. doi: 10.7326/0003-4819-158-5-201303051-00011.
Hospitals now have the responsibility to implement strategies to prevent adverse outcomes after discharge. This systematic review addressed the effectiveness of hospital-initiated care transition strategies aimed at preventing clinical adverse events (AEs), emergency department (ED) visits, and readmissions after discharge in general medical patients. MEDLINE, CINAHL, EMBASE, and Cochrane Database of Clinical Trials (January 1990 to September 2012) were searched, and 47 controlled studies of fair methodological quality were identified. Forty-six studies reported readmission rates, 26 reported ED visit rates, and 9 reported AE rates. A "bridging" strategy (incorporating both predischarge and postdischarge interventions) with a dedicated transition provider reduced readmission or ED visit rates in 10 studies, but the overall strength of evidence for this strategy was low. Because of scant evidence, no conclusions could be reached on methods to prevent postdischarge AEs. Most studies did not report intervention context, implementation, or cost. The strategies hospitals should implement to improve patient safety at hospital discharge remain unclear.
医院现在有责任实施策略，以防止出院后的不良后果。本系统评价针对旨在预防一般医疗患者临床不良事件（AE）、急诊部（ED）就诊和出院后再入院的医院发起的护理交接策略的有效性。检索了 MEDLINE、CINAHL、EMBASE 和 Cochrane 临床试验数据库（1990 年 1 月至 2012 年 9 月），并确定了 47 项具有良好方法学质量的对照研究。46 项研究报告了再入院率，26 项报告了 ED 就诊率，9 项报告了 AE 率。有专门交接人员的“桥梁”策略（结合了出院前和出院后的干预措施），在 10 项研究中降低了再入院或 ED 就诊率，但这种策略的总体证据强度较低。由于证据不足，对于预防出院后 AE 的方法，无法得出结论。大多数研究没有报告干预的背景、实施情况或成本。医院应实施哪些策略来提高出院时的患者安全性仍不清楚。
