Do postdischarge contacts lead to fewer ED use, readmissions?

A recent study has shown that postdischarge contacts (PDC) within 7 days of discharge do not appear to reduce emergency department (ED) use or readmissions within 30 days relative to usual care.

A team of investigators systematically searched the databases of Medline, Embase, and Cinahl from 2012 to 25 May 2023 for randomized and nonrandomized trials of PDC within 7 days. Two investigators screened articles and assessed risk of bias (ROB) separately, while single reviewers extracted data, which was verified by second investigators.

Outcomes from at least three studies were included in random-effect meta-analyses. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to evaluate the certainty of evidence.

Thirteen studies (11 randomized trials) met the eligibility criteria, of which 12 delivered PDCs via telephone. Three of the 11 randomized trials had low ROB, and only one had a high ROB. Most PDC interventions (n=10) involved a single telephone contact, often within 3 days. Eight studies focused on patients who were deemed as higher-risk by the investigators.

At 30 days, ED use (five randomized trials, n=3,054 patients; risk difference, 0.00, 95 percent confidence interval [CI], –0.02 to 0.03; moderate certainty) or hospital readmissions (seven randomized trials, n=7,075 patients; risk difference, 0.00, 95 percent CI, –0.02 to 0.02; moderate certainty) showed no differences with PDC.

“Health systems should reconsider the utility of universal PDCs because multifaceted interventions targeting higher-risk patients may be necessary to reduce use of acute care after discharge,” the investigators said. 

The study was limited by the poorly described adherence and fidelity to PDC interventions, and only one study examined nontelephone PDC.