Key result
Systematic review identifies cognitive, systemic, environmental, and communication barriers disrupting hospital-to-home transitions.
Why the study?
Communicative and environmental friction points burdening nursing practice during acute hospital-to-home transitions remain fragmented in the literature, often overlooking the complex realities that impede effective patient education.
Systematic Review (n=30)
The hospital-to-home transition is hindered by systemic, communicative, and environmental barriers, requiring workflow redesigns and structured comprehension verification to improve patient safety.
Answers are grounded in this paper and cite their sources.
Hospital-to-home transitions require workflow redesigns and comprehension checks; challenges idealized discharge models and extends evidence for barrier-targeted interventions.
Background: The acute hospital-to-home transition is a period of profound clinical vulnerability. While systems track readmission metrics, the communicative and environmental friction points burdening nursing practice remain fragmented in the literature. Current models frequently treat discharge as an idealized administrative task, overlooking the complex realities of the “discharge danger zone” that impede effective patient education. Objective: This systematic review synthesizes international empirical evidence to identify the pervasive communication failures, inter-professional workflow constraints, and cognitive-environmental barriers disrupting the clinical provider-to-home handoff. Methods: Designed as a mixed-methods systematic review (PROSPERO: CRD420261435583) guided by JBI methodology, a search of 6 databases identified 30 peer-reviewed empirical studies published between 2020 and 2026. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were synthesized using a convergent integrated mixed-methods approach. Results: Four macro-themes mapping transition breakdowns emerged: (1) Cognitive, Psychosocial, and Health Literacy Barriers; (2) Systemic and Workflow Friction Points (e.g., rushed timelines, fragmented coordination); (3) Environmental, Socioeconomic, and Structural Home Barriers; and (4) Communication Quality and Information Processing Breakdowns (e.g., medical jargon, lack of comprehension verification). These intersecting forces routinely sabotage patient education, cultivating a perilous “illusion of comprehension.” Conclusion: The hospital-to-home transition is a complex inter-professional communication event, not merely a medical transaction. To enhance patient safety, nursing leadership must advocate for systemic workflow redesigns that decouple transition education from the rushed point of exit, mandate structured comprehension verification, and implement interventions accommodating patient cognitive load and diverse social environments.
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Hasib et al. (2026) conducted a systematic review in Hospital-to-home transitions (n=30). Systemic, communicative, and inter-professional barriers was evaluated on Transition breakdowns and barriers. A systematic review of 30 empirical studies identified four macro-themes of barriers disrupting hospital-to-home transitions: cognitive, systemic, environmental, and communication breakdowns.
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