Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis

Tyler, Natasha; Wright, Nicola; Waring, Justin

Abstract

Background: The transition from acute mental health inpatient to community care is often a vulnerable period in the pathway, where people can experience additional risks and anxiety. Researchers globally have developed and tested a number of interventions that aim to improve continuity of care and safety in these transitions. However, there has been little attempt to compare and contrast the interventions and specify the variety of safety threats they attempt to resolve. Methods: The study aimed to identify the evidence base for interventions to support continuity of care and safety in the transition from acute mental health inpatient to community services at the point of discharge. Electronic Databases including PsycINFO, MEDLINE, Embase, HMIC, CINAHL, IBSS, Cochrane Library Trials, ASSIA, Web of Science and Scopus, were searched between 2000 and May 2018. Peer reviewed papers were eligible for inclusion if they addressed adults admitted to an acute inpatient mental health ward and reported on health interventions relating to discharge from the acute ward to the community. The results were analysed using a narrative synthesis technique. Results: The total number of papers from which data were extracted was 45. The review found various interventions implemented across continents, addressing problems related to different aspects of discharge. Some interventions followed a distinct named approach (i.e. Critical Time Intervention, Transitional Discharge Model), others were grouped based on key components (i.e. peer support, pharmacist involvement). The primary problems interventions looked to address were reducing readmission, improving wellbeing, reducing homelessness, improving treatment adherence, accelerating discharge, reducing suicide. The 69 outcomes reported across studies were heterogeneous, meaning it was difficult to conduct comparative quantitative meta-analysis or synthesis. Conclusions: The interventions reviewed are spread across a spectrum ranging from addressing a single problem within a single agency with a single solution, to multiple solutions addressing multi-agency problems. We recommend that future research attempts to improve homogeneity in outcome reporting.

Citation

Tyler, N., Wright, N., & Waring, J. (2019). Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis. BMC Health Services Research, 19, Article 883. https://doi.org/10.1186/s12913-019-4658-0

• Journal Article Type: Article
• Acceptance Date: Oct 16, 2019
• Online Publication Date: Nov 25, 2019
• Publication Date: 2019-12
• Deposit Date: Oct 22, 2019
• Publicly Available Date: Nov 26, 2019
• Journal: BMC Health Services Research
• Electronic ISSN: 1472-6963
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Article Number: 883
• DOI: https://doi.org/10.1186/s12913-019-4658-0
• Keywords: Systematic review; Care transitions; Mental health; Interventions; Discharge; Acute services; Psychiatric discharge; Hospital discharge
• Public URL: https://nottingham-repository.worktribe.com/output/2918227
• Publisher URL: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4658-0
• Additional Information: Received: 6 June 2019; Accepted: 20 October 2019; First Online: 25 November 2019; : Not Applicable.; : Not Applicable.; : The authors declare that they have no competing interests.