Review of trials shows that many different interventions have positive effects on patient care outcomes, but cannot confirm the optimal approach.
By Mandy Huggins, MD
September 14, 2012 — Interventions aimed at improving quality of patient handovers are effective, although firm conclusions cannot be made, according to a literature review performed by scientists in the Netherlands.
The authors reviewed randomized, controlled trials of interventions intended to improve the transition from hospital discharge to primary care. A search of PubMed, CINAHL, PsycInfo, the Cochrane Library, and EMBASE for studies published between January 1990 and March 2011 resulted in 36 studies for evaluation.
According to the study team, led by Gijs Hesselink, MA, MSc, from the Radboud University Nijmegen Medical Centre in the Netherlands, and colleagues, there is a need to improve transition from hospital stay to primary care. Suboptimal transitions can result in rehospitalization, adverse medical events, and death.
Previous research indicates that as many as 62% of reported adverse events after discharge can be prevented. The authors also cited an increasing number of elderly and/or chronically ill patients transitioning between healthcare facilities as a need to further evaluate patient handover interventions.
According to the study findings, effective interventions include “medication reconciliation; electronic tools to facilitate quick, clear, and structured summary generation; discharge planning; shared involvement in follow-up by hospital and community care providers; use of electronic discharge notifications; and web-based access to discharge information for general practitioners.”
Because of variations between the studies in methods of intervention, patient population, and outcome definitions and measurements, firm conclusions could not be made regarding most effective intervention strategies. Meta-analysis also could not be performed.
Most (69.4%) studies showed statistically significant effects between the control and intervention groups. Almost all (94.4%) had multiple components in the intervention.
“The mechanisms underlying these interventions that improve the quality and safety of handovers between hospital and primary care providers at discharge is still unknown,” the authors conclude. “Our review also outlines a rich area for several key research questions, including developing a clearer description of the interventions, using uniform and valid outcome measures, and attending to the care provider’s attitudes and training in developing effective handover interventions.”
In a related editorial, Susan T. Bray-Hall, MD of the University of Colorado School of Medicine in Denver notes that in addition to the previously mentioned outcomes, “patient-centered outcomes should also be the focus of our work and should include mortality, functional status, quality of life, and caregiver burden.”
Dr. Bray-Hall also reports that “these 2 quality reviews of the current body of evidence about transitional care begin to identify important gaps in available research.”
Grant support was provided by the European Union, the Framework Programme of
the European Commission (FP7-HEALTH-F2-2008-223409).The authors and editorialist report no relevant financial conflicts.
Ann Intern Med. 2012;157:417-428.