Early supported discharge for older adults admitted to hospital with medical complaints: a protocol for a systematic review

Optimal Evidence Summary for Discharge Preparation in Elderly Chemotherapy Patients

Objective

This study aims to systematically search, screen, evaluate, and synthesize evidence related to discharge preparation for elderly chemotherapy patients, providing an evidence-based reference for implementing discharge preparation services for this demographic.

Methods

Systematic searches were conducted on databases including BMJ Best Clinical Practice, JBI Library, UpToDate Clinical Advisor, Cochrane Library, and relevant guideline websites. The collected literature comprised thematic summaries, clinical practice guidelines, technical reports, expert consensus, and systematic reviews related to discharge preparation for elderly chemotherapy patients. Relevant evaluation tools were selected based on the type of literature to assess methodological quality, and the evidence was extracted, summarized, and organized.

Results

Fifteen pieces of evidence were selected according to inclusion and exclusion criteria, including one clinical decision, two expert consensuses, six systematic reviews, two meta-analyses, and four guidelines. Twenty-nine pieces of evidence were summarized across four domains: assessment, planning, implementation, and evaluation.

Conclusion

The summarized evidence provides a reliable basis for implementing evidence-based discharge preparation services for elderly chemotherapy patients, laying a foundation for future clinical practice applications. Based on the evidence content and relevant literature, this paper explores the screening and evaluation tools applicable for use in clinical practice.

Early supported discharge for older adults admitted to hospital with medical complaints: a systematic review and meta-analysis

INTRODUCTION

Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home and continue to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. The concept has shown reduced length of stay and improved functional outcomes in stroke patients. This systematic review aims to explore the totality of evidence for the use of early supported discharge in older adults hospitalised with medical complaints.

METHODS

A literature search of CINAHL in EBSCO, Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE and MEDLINE in EBSCO was carried out. Randomised controlled trials or quasi-randomised controlled trials were included. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment. The primary outcome measure was hospital length of stay. Secondary outcomes included mortality, function, health related quality of life, hospital readmissions, long-term care admissions and cognition. A pooled meta-analysis was conducted using RevMan software 5.4.1.

RESULTS

Five studies met the inclusion criteria. All studies were of some concern in terms of their risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (REM, MD = -6.04, 95% CI -9.76 to -2.32, I2 = 90%, P = 0.001). No statistically significant effects favouring ESD interventions were established in secondary outcomes.

CONCLUSION

ESD interventions can have a statistically significant impact on the length of stay of older adults admitted to hospital for medical reasons. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.