A Structured Evidence-Based Literature Review on Discharge, Referral and Admission

Executive summary This document provides three structured evidence-based literature reviews on the benefits, enablers, barriers and challenges related to the processes of discharge, referral and admission covering Australian and International published works. The reviews are presented in a manner that includes summaries of papers, reviews the strength of evidence and synthesizes major themes and issues. These reviews are specifically focused on discharge, referral and admission processes in the healthcare sector, particularly concentrating on literature published in the last ten years and covering both quantitative and qualitative research. While the primary source of materials on discharge, referral and admission processes are from within the Medline collection, the review also includes materials in journals outside that collection as well as other published material on the topic, including non- peer-reviewed papers, opinions and published reports. The reviews are focused on identifying and analysing available literature on the processes of discharge, referral and admission in relation to the following six key questions: 1. What is the current practice to date along with barriers to, and facilitators of success, relating to: o o o Safety (including high risk scenarios); Efficiency (costs and benefits); Sustainability and quality (effectiveness). high risk scenarios can be identified from the literature? interventions in this area were most effective? were the critical success factors or limitations of their effectiveness? 2. What 3. What 4. What 5. Is there evidence of sustainability and transferability for these interventions? 6. What are the gaps in evidence is this area? In relation to literature on discharge processes, the review also aims to provide critical appraisals of the evidence in relation to a number of more specific questions including those related to discharge summary receipt experiences; impact on medication management, on patient outcomes, and financial effectiveness of different types of discharge processes; and, the role of communication frameworks. Although the scope of the document as a whole aims to review literature on the three processes of discharge, referral and admission, it was recognised from the outset that a greater volume of literature would be available relating to discharge and that this was likely to become the major focus for the document. Following an introduction, the approach utilised in the identification and analysis of literature relevant to addressing these questions is presented. The document is then structured into four parts. The first three parts present free-standing structured reviews of literature on the processes of discharge, referral and admission respectively. A brief fourth part of the document adopts a continuity of care perspective, and highlights some of the important inter- relationships that are marginalised, excluded or ignored by the literature specifically focused on discharge, referral and admission processes. Whilst the document presents three free-standing structured literature reviews, the eHealth Services Research Group (eHSRG) encourage readers to consider the inter-relationships between them. Part four of this document aims to support these considerations by maintaining an integrated care perspective. More specifically, part four aims to briefly highlight the limitations, challenges and dangers of simply focusing on the evidence, or gaps in evidence identified in the individual reviews presented in Parts 1, 2 and 3. In conducting these reviews, the team grappled with the definitional challenges presented by each of the three terms. Aside from the inherent ambiguity of each of the terms per se, there is also a lack of any universally recognised definition for the processes within the healthcare sector to which these terms refer. For example, ‘admission’ is routinely used to describe the intake of a patient into a hospital, an emergency departmen