Effectiveness of strategies to promote safe transition of elderly people across care settings.

Background: Errors and adverse events have major impact on elderly patients due to their recurrent hospitalisation and particularly as they move between settings to receive care for comorbid chronic conditions. A range of strategies such as discharge planners, use of patients transfer sheet, medications reconciliation and patients education have been implemented to improve care transition. However, there have been no systematic reviews undertaken to evaluate the effectiveness of these strategies in a concise format for the development of evidence-based guidelines. Therefore, a systematic review is urgently needed to support clinicians in implementing safe quality care transition and also use as a front line to improve patient safety.

Objective: The objective of this review is to appraise and synthesise the best available evidence in promoting a safer transfer of elderly patients across care settings.

Selection Criteria: Types of studies Only randomised controlled trials (RCTs) evaluating the effectiveness of strategies to promote safe transfer of elderly patients across care settings were eligible for inclusion in this review.Types of participants The review included studies undertaken in participants aged >65 years who have been transferred between care settings.The review focused on any interventions that were undertaken to reduce or minimise errors and adverse events and promote safe transition of the elderly patients from one setting to another.The primary outcome of interest was the effect of the interventions on the use of health care resources.

Search Strategy: A comprehensive search of the literature published in the English language was undertaken using all major electronic databases ranging from 1966 to 2008. Reference lists and bibliographies of all possible trials and reviews of studies were searched. Relevant conference proceedings were searched; experts in the field were also contacted to identify further trials.

Results: 12 studies were included in the review. The results indicated that comprehensive plan of care and well-trained healthcare practitioners such as nurses or pharmacists, who have current information about the patient's clinical status and care plan, ensured smoother transition from hospital to home. The use of multi-faceted interventions such as elderly patient education and collaborative team approach reduce the incidence of errors and adverse events during care transition.

Conclusion And Implication For Practice: There is evidence of benefits to demonstrate:1. Strategies that involve structured communication improve outcomes for elderly patients during care transition.2. Nurse-led interventions and multidisciplinary team interventions were effective in reducing readmission to hospital at one to nine months.3. Pharmacist-led interventions and multidisciplinary team led interventions reduced frequency of hospital services utilisation such as emergency visits, long-term institutions and rehabilitation clinics.4. Pharmacist-led interventions were effective in improving quality of medications prescribed by physician. In addition, significantly reduced non-adherence in patients taking four or more medication at three months.5. Nurse-led interventions effectively improved quality of life in patients receiving the interventions.6. Nurse-led and multidisciplinary team led interventions reduced costs associated with the interventions.

Implication For Research: The review has provided a guide for future research priorities which involves larger randomised controlled trials assessing transitions between hospital and in-patient settings; comprehensive standardised method to assess outcomes such as medication adherence and studies to clearly demonstrate the association between adverse events and transfer.