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National Guideline Centre (UK). Emergency and acute medical care in over 16s: service delivery and organisation. London: National Institute for Health and Care Excellence (NICE); 2018 Mar. (NICE Guideline, No. 94.)
Emergency and acute medical care in over 16s: service delivery and organisation.
Show detailsTable 5Clinical evidence profile: Discharge planning versus standard processes
| Quality assessment | No of patients | Effect | Quality | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No of studies | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Discharge | standard processes | Relative (95% CI) | Absolute | ||
| Readmission (follow-up 30 days; assessed with: number readmitted) | ||||||||||||
| 1 | randomised trials | serious1 | no serious inconsistency | serious2 | serious3 | none | - | 0% | HR 1.17 (0.79 to 1.73) | - |
⨁◯◯◯ VERY LOW | IMPORTANT |
| Readmission (follow-up 5-30 days; assessed with: number readmitted) | ||||||||||||
| 3 | randomised trials | serious1 | no serious inconsistency | no serious indirectness | serious3 | none |
74/493 (15%) | 20.7% | RR 0.74 (0.56 to 0.98) | 54 fewer per 1000 (from 4 fewer to 91 fewer) |
⨁⨁◯◯ LOW | IMPORTANT |
| Mortality (follow-up 5 days -12 months; assessed with: number of deaths) | ||||||||||||
| 4 | randomised trials | no serious risk of bias | no serious inconsistency | no serious indirectness | serious3 | none |
98/824 (11.9%) | 10% | RR 1.13 (0.87 to 1.48) | 13 more per 1000 (from 13 fewer to 48 more) |
⨁⨁⨁◯ MODERATE | CRITICAL |
| Mortality (follow-up 6 months; assessed with: number of deaths) | ||||||||||||
| 1 | randomised trials | no serious risk of bias | no serious inconsistency | serious2 | very serious3 | none | - | 0% | HR 0.54 (0.23 to 1.27) | - |
⨁◯◯◯ VERY LOW | CRITICAL |
| Mortality (in-hospital) (follow-up during admission; assessed with: number of deaths during admission) | ||||||||||||
| 1 | randomised trials | no serious risk of bias | no serious inconsistency | serious2 | very serious3 | none |
3/51 (5.9%) | 8.3% | RR 0.71 (0.18 to 2.81) | 24 fewer per 1000 (from 68 fewer to 150 more) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Avoidable adverse events (follow-up 1-5 days; assessed with: adverse medicine reaction) | ||||||||||||
| 1 | randomised trials | very serious1 | no serious inconsistency | serious2 | very serious3 | none |
3/30 (10%) | 6.7% | RR 1.5 (0.27 to 8.34) | 34 more per 1000 (from 49 fewer to 492 more) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Avoidable adverse events (follow-up 12 months; assessed with: falls) | ||||||||||||
| 1 | randomised trials | very serious1 | no serious inconsistency | no serious indirectness | very serious3 | none |
13/30 (43.3%) | 50% | RR 0.87 (0.5 to 1.49) | 65 fewer per 1000 (from 250 fewer to 245 more) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Quality of life (follow-up 180 days; assessed with: minimal clinically important difference on St. George’s Respiratory Questionnaire) | ||||||||||||
| 1 | randomised trials | serious1 | no serious inconsistency | serious2 | very serious3 | none |
24/63 (38.1%) | 41.7% | RR 0.91 (0.6 to 1.39) | 38 fewer per 1000 (from 167 fewer to 163 more) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Quality of life (follow-up 7 days; measured with: medical outcomes study short form 12 - physical ratings; Better indicated by higher values) | ||||||||||||
| 1 | randomised trials | very serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | none | 91 | 98 | - | MD 0 higher (1.23 lower to 1.23 higher) |
⨁⨁◯◯ LOW | CRITICAL |
| Quality of life (follow-up 7 days; measured with: medical outcomes study short form 12 - mental ratings; Better indicated by higher values) | ||||||||||||
| 1 | randomised trials | very serious1 | no serious inconsistency | no serious indirectness | serious3 | none | 91 | 98 | - | MD 1.5 higher (0.11 lower to 3.11 higher) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Patient satisfaction (follow-up 7 days; measured with: rating of discharge process; Better indicated by higher values) | ||||||||||||
| 1 | randomised trials | very serious1 | no serious inconsistency | no serious indirectness | serious3 | none | 91 | 98 | - | MD 0.21 higher (0.05 to 0.37 higher) |
⨁◯◯◯ VERY LOW | CRITICAL |
| Patient satisfaction (follow-up 30 days; assessed with: preparedness to leave hospital (prepared or very prepared)) | ||||||||||||
| 1 | randomised trials | serious1 | no serious inconsistency | no serious indirectness | serious3 | none |
197/307 (64.2%) | 52.9% | RR 1.21 (1.06 to 1.39) | 111 more per 1000 (from 32 more to 206 more) |
⨁⨁◯◯ LOW | CRITICAL |
| Length of stay (measured with: days in hospital; Better indicated by lower values) | ||||||||||||
| 5 | randomised trials | serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | none | 661 | 676 | - | MD 0.58 lower (1.45 lower to 0.28 higher) |
⨁⨁⨁◯ MODERATE | CRITICAL |
| Staff satisfaction (follow-up 7 days; measured with: GP satisfaction; Better indicated by higher values) | ||||||||||||
| 1 | randomised trials | very serious1 | no serious inconsistency | no serious indirectness | no serious imprecision | none | 91 | 98 | - | MD 0.18 lower (0.37 lower to 0.01 higher) |
⨁⨁◯◯ LOW | IMPORTANT |
- 1
Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.
- 2
Downgraded by 1 or 2 increments because the majority of the evidence was based on indirect interventions (interventions included post discharge components).
- 3
Downgraded by 1 increment if the confidence interval crossed 1 MID or by 2 increments if the confidence interval crossed both MIDs.
- Table 5, Clinical evidence profile: Discharge planning versus standard processes...Table 5, Clinical evidence profile: Discharge planning versus standard processes - Emergency and acute medical care in over 16s: service delivery and organisation
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