Clinical Question

Do individualized discharge plans shorten the length of hospital stays or reduce hospital readmission rates?

Evidence-Based Answer

Older patients (i.e., 60 to 84 years of age) who are hospitalized but not undergoing surgery and who have individualized discharge plans have shorter hospital stays compared with patients who receive standard care only (mean difference = −0.73 days; 95% CI, −1.33 to −0.12). (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.) Patients with individualized discharge plans have lower rates of unscheduled hospital readmissions during an average of three months of follow-up (absolute risk reduction [ARR] = 2.9%; 95% CI, 0.8% to 7.1%; number needed to treat [NNT] = 34; 95% CI, 14 to 125).¹ (SOR: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Delays in hospital discharge occur when a patient is medically fit to be discharged home or to another setting, but arrangements for transfer and subsequent care are not in place. In the United States in 2014, the average length of stay for any hospital admission was 6.1 days, and in government-affiliated hospitals it was 10.3 days.² Delayed discharges place a significant burden on the health care system by decreasing the number of available hospital beds. They lead to worse patient outcomes, can cause distress to patients and their families, and increase overall health care costs.^3,4 Individualized discharge plans may decrease the duration of hospital stays and reduce the risk of hospital readmissions by reconciling treatment plans, educating patients and families, and facilitating outpatient follow-up.^1,3,4