The successful transition from inpatient to outpatient psychiatric care is an important step along the road to recovery. It can be a difficult and turbulent time for patients, so much so that there is a risk that patients will suffer a relapse of their illness and need to be readmitted into hospital (Herman, Mattke, Somekh et al., 2006).  In the UK around 13% of patients get readmitted shortly after discharge (Leslie and Rosenheck, 2000). This causes further disruption to patients lives and is a costly use of limited time and resources.

The risk of patients needing readmission could be reduced by taking steps to support transition from care (Steffen, Koster, Backer, and Puschner, 2009). Psychosocial training, for instance, can be used to teach patients ‘life skills’ to help them cope better when adjusting to life after treatment.  A new systematic review by Vigod, Kurdyak, Dennis and Leszcz et al., (2013) was carried out to compare the different ways in which researchers have attempted to reduce psychiatric patient readmission rates.

Methods

• A systematic search (Medline, CINAHL EMBASE, PsychINFO and the Cochrane Library) was conducted to identify interventions designed to support adult patients transition from inpatient to outpatient psychiatric care
• Studies were included if they had a specific transition intervention component where participant readmission rates were recorded

Results

The authors identified a range of different interventions which were designed to reduce readmission both pre and post discharge, and interventions which spanned both (bridging). Of those interventions that successfully reduced readmission, the authors highlight the benefits of:

Pre-discharge:

• Psycho education
• Medication education

Post-discharge:

• Psycho education
• Telephone and home visits
• Transition manager
• Structured needs assessment

Bridging:

• Transition manager
• Discharge plan

Conclusions

The researchers concluded:

We observed that transitional care interventions with pre-discharge, post-discharge and/or bridging components may reduce early psychiatric readmission – and that when they are effective, the magnitude of effect appears to be clinically meaningful

The key strength of this review is the diverse list of potential ways to support patients transition to outpatient care. This review is a useful starting place when considering how readmission rates could be reduced, but caution needs to be taken when considering if these findings could be transferred to other contexts because of the small, non-representative samples used in most of the included studies.  This issue is compounded by the fact that many of the interventions only worked in some of studies they were used in.  So, the effects on reducing readmission does seem to be context dependent.

A bigger problem with this study is that it only assessed the short term effects of interventions. Whilst short term reduction in readmission could have some benefit to patients, reducing the need for readmission in the long run would be much more beneficial.  The authors report that readmission rates for many of the interventions reviewed were much higher and almost the same as control groups after 6-24 months, suggesting that many of the interventions did little to reduce patient readmission in the long run.

In short, the need for readmission following psychiatric treatment is a serious issue and readmission rates need to be lowered.  This new review has highlighted a range of different ways in which psychiatric readmission can be reduced. Although the evidence to support the different interventions is inconsistent, these results certainly suggest that there are plenty of different opportunities and options when trying to reduce psychiatric readmission.

Links

Vigod S, Kurdyak PA, Dennis CL, Leszcz T, Taylor VH ,Blumberger DM and Seitz DP. Transitional intervention to reduce early psychiatric readmissions in adults: systematic review. The British Journal of Psychiatry 2013; 202, 187-194.

Leslie DL, Rosenheck, RA. Comparing quality of mental health care for public sector and privately insured populations. Psychiatr Serv 2000; 51, 650-655

Hermann RC, Mattke S, Somekh D,  Silfverhielm H, Goldner E, Glover G, et al. Quality indicators for international benchmarking of mental health care. int J Qual Health Care 2006; 18 (suppl 1) 31-38.

Steffen S, Kosters M, Becker T, Puschner B. Discharge Planning in mental health care: a systematic review of the recent literature. Acta Psychiatr Scand 2009; 120 1-9.