Systematic Review and Review Literature Review Chapter

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EBP is to facilitate strategy to eradicate short cycle return to second readmission of psychiatric patients on hospital beds. Doing so will assist health care providers in addressing the issue of bed shortage. Reduction of readmission rates allows more space to be available for other patients and helps to cut costs as well as bring about better conformity with governmental regulations.

Search Process

The search process used in this literature review began with searching key words in online databases such as Cochran Review, CINAHL, and other nursing research journal databases. Google Scholar was used as the primary search engine, with filters set to permit results from these particular databases. Key words used included "reducing readmission rates," "readmission psych," "causes of readmission psych hospital," "psych hospital readmission," "reduction of psych readmission," and other combinations of key words identified by relevant articles found after conducting these searches. More than a thousand articles were yielded in the various searches. These number were trimmed according to relevance and to year produced, with only the most recent studies being chosen for the final selection. Common key words among relevant articles were also used to conduct more searches until a collection of a 15 articles were gathered. The hierarchy of evidence was then used to select the strongest studies, including a systematic review and a randomized-control trial. Articles that were not selected included case editorials and studies where no clear conclusion was obtained by the researchers.

Critical Appraisal

The critical appraisal process utilized for this literature review included identifying the results of the studies, assessing the validity of the studies, determining whether the results of the studies would facilitate patient care, recognizing similarities between the subjects of the study and the patients who are the focus of this EBP, and whether the study was qualitative or quantitative in nature. Studies selected for this review were then ranked according to strength in terms of the hierarchy of evidence, with systematic reviews and meta-analyses ranking as the strongest at Level 1, randomized-controlled trials next at Level 2, and case reports last at Level 7.

The studies selected for this review were:

Burns, T., Rugkasa, J., Molodynski, A. et al. (2013). Community treatment orders for patients with psychosis (OCTET): A randomized controlled trial. The Lancet, 381(9878): 1627-1633.

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DOI: http://dx.doi.org/10.1016/S0140-6736(13)60107-5.

This study is randomized controlled trial of the second highest level of strength (with definitive results) according to the hierarchy of evidence (Level 2).

Kalseth, J., Lassemo, E., Wahlbeck, K., Haaramo, P., Magnussen, J. (2016). Psychiatric

readmissions and their association with environmental and health system characteristics: a systematic review of the literature. BMC Psychiatry, 16: 376. DOI: 10.1186/s12888-016-1099-8.

This study was a systematic review and thus of the highest level of evidence at Level 1.

Kripalani, S., Theobald, C., Anctil, B., Vasilevskis, E. (2013). Reducing hospital readmission: Current strategies and future directions. Annual Review of Medicine, 65: 471-485. DOI: 10.1146/annurev-med-022613-090415

This study is another systematic review and thus at the highest level (1) of hierarchy of evidence.

Tulloch, A., David, A., Thornicroft, G. (2016). Exploring the predictors of early readmission to psychiatric hospital. Epidemiology and Psychiatric Sciences, 25(2): 181-193.

This study was a case control study (Level 5) in the hierarchy of evidence.

Vigod, S., Kurdyak, P, Dennis, C. et al. (2013). Transitional interventions to reduce early psychiatric readmissions in adults: Systematic review. The British Journal of Psychiatry, 202(3): 187-194. DOI: 10.1192/bjp.bp.112.115030.

This systematic review is another study at the highest level of strength in the hierarchy of evidence (Level 1).

Results of the Studies

The study by Kalseth et al. (2016) found that "the risk of readmission not only relates to patient characteristics but also to system and/or environmental factors that vary between areas." The researchers also acknowledged a lack of studies that analyze the relationship between payment model and readmissions and suggest that financing systems could be a major variable in readmission rates. This is applicable to the PICOT of the EBP because the Eric Coleman care transition model is based on the idea of utilizing services to ensure optimum communication and care for continual, safe, quality care through periods of transition for the patient so that readmission does not become an issue. As this study indicates, environmental factors are unique in many cases for patients and must be considered on a case by case basis. In other words, there is no one-size-fits-all patient approach for transitions: providers must assess each patient's needs individually in order to ensure a smooth transition and to mitigate the risk of readmission of patients.

Vigod.....

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