Table 2 Summary of reviews on readmissions Paper Author and date published Description of study Type of review Main findings for readmissions CASP score Paper Author Description of intervention Type of review Results CASP score Risk factors for hospital readmission in elderly patients: a systematic review L, 2011[] Systematic review of 12 prospective cohort studies (13,183 patients) in people aged 75 years or more to identify risk factors for readmission Systematic review Need for increased vigilance of older people with previous hospital admission, long length of stay, comorbidities and functional status 12/14, 86% Evidence based risk factors for adverse health outcomes in older patients after discharge home and assessment tools Preyde M, 2011[] Systematic review of 43 research articles to ascertain risk factors for adverse outcomes for older people discharged from acute care facilities. Also to evaluate risk assessment tools Narrative literature review Paucity of published research Most commonly mentioned risk factors were depression, poor cognition, number of comorbidities, length of stay, prior hospital admission, functional status, patient age, multiple medications and lack of social support people at risk of adverse outcome may benefit from comprehensive discharge planning 7/14, 50% Discharge planning from hospital to home (Cochrane review) Shepperd S, 2013[] Meta-analysis of 24 RCTs (8098 patients) – 16 of RCT exclusively recruited older people in mixed medical & surgical settings Explores effectiveness of discharge planning vs non specialised ‘usual care’ Meta - analysis Significant reduction in readmission rate (RR 0.82, 95% CI 0.73 to 0.92) In addition significant impact on length of stay No impact on mortality Little evidence on cost 14/16, 88%
A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’ Conroy S, 2011[] Systematic review of 5 Randomised controlled trials (2287 patients) comparing usual care to CGA in emergency departments or acute medical units Systemic review No clear evidence of benefit of CGA to prevent readmissions from short hospital stays RR 0.95 (95% CI 0.83 to 1.08). Also no significant benefit in terms of mortality. 14/16, 88% Interventions to reduce hospital readmission in the elderly: or home care. A systematic review Linertova R, 2010[] Systematic review of 32 clinical trials (25 RCTs, 7 CCTs) evaluating interventions to reduce hospital readmission in people >75 and role of home follow up Narrative literature review Most of the interventions evaluated had no effect on readmissions. Those which included post-discharge home care components seemed more likely to reduce readmissions 13/14, 93% Interventions to reduce 30-day a systematic review Hansen L, 2011[] 43 articles (patients 882,182) Aims to describe interventions which reduce hospitalisation at 30 days post discharge Age group not specified 9/16 RCTs had sample size <100; other controlled studies; incomplete reporting common No single or bundled intervention implemented was consistently associated with reduced risk for rehospitalisation 12/14, 86% Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane review Ellis G, 2011[] Meta-analysis of 22 trials (10,315 patients) Aim to evaluate the effectiveness of CGA in hospital for older adults admitted as an emergency Meta-analysis Readmission rates no different (3822 patients, RR 1.03 [0.89-1.18] but patients in receipt of CGA were more likely to be alive and in their own homes at up to six months 15/16, 94% day