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

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.