A systematic review of the effectiveness of nurse coordinated transitioning of care on readmission rates for patients with heart failure

BACKGROUND: Readmission rates for patients with heart failure are a major concern for hospitals worldwide. The importance of patient education and a structured care plan to ease the transition from hospital to home has been the focus of many intervention strategies to reduce readmission rates. The use of transitioning of care plans is believed to improve medication reconciliation, communication, patient education, and follow-up. To date, the evidence has not been systematically evaluated to support the effectiveness of a nurse coordinated transitioning of care for patients with heart failure in reducing readmission rates. OBJECTIVE: The objective of the systematic review was to identify the best available evidence on the effectiveness of nurse coordinated transitioning of care between hospital and home on hospital readmission rates for all causes in adult patients hospitalised with heart failure. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies in the English language from January 1975 through July 2010. A search of MEDLINE, CINAHL, PsycINFO, Healthsource Nursing/academic edition, EMBASE, the Cochrane Library, and the Joanna Briggs Institute Library of Systematic Reviews was conducted followed by a reference search of relevant studies. The initial key words searched were: heart failure, readmission, and transitional care. INCLUSION CRITERIA: Randomised controlled trials that evaluated the effect of nurse coordinated transitioning of care from hospital to home in adult patients with heart failure on readmission rates were selected. The outcome was defined as hospital readmissions for all causes following an initial admission for heart failure. DATA COLLECTION AND ANALYSIS: Studies selected for retrieval were critically evaluated by two independent reviewers for methodological validity using standardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted and analysed using the JBI-MAStARI program. RESULTS: A total of 16 randomised controlled studies were included. Ten of the 16 studies included in the review show that a nurse led transitioning of care intervention can reduce the rate of readmission for patients with heart failure. Interventions utilising home visits, or home visits coupled with telephone follow-up, show a more favourable reduction in readmission rates. CONCLUSIONS: Reduced readmissions occur when transitioning of care interventions are carried out by a heart failure trained nurse who conducts at least one home visit and follows the patient at least weekly for a minimum of 30 days post discharge with either additional home visits or telephone contact. IMPLICATIONS FOR PRACTICE: This review supports the development of a nurse coordinated transitioning of care plan which will require improvements in communication, in addition to changes in health policy and payment systems that align incentives and performance measures in caring for patients with heart failure. IMPLICATIONS FOR RESEARCH: Future research should evaluate the effect of the intensity and duration of the transitioning of care intervention on readmission rates in a large randomised control trial on an adult population with heart failure to determine the ideal frequency and duration of the post discharge interventions.