Scoping Review of Adult Emergency Department Discharge Interventions

The discharge process is a crucial component of the emergency department (ED) encounter, with poor discharge quality often leading to negative patient outcomes. While numerous interventions have been implemented to improve this process, a comprehensive review of these interventions has not been conducted. This study provides a scoping, summative review of adult ED discharge interventions to date, evaluating the literature for potential best practices and future directions.

We conducted a scoping review of published literature on MEDLINE ALL (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials (Wiley), and CINAHL (EBSCOhost) on February 7, 2023, for articles reporting on ED-based discharge interventions. We excluded the following: studies involving pediatric patient populations; discharge from non-ED settings; in-ED risk screening and/or case management as the primary intervention; interventions occurring mostly after the ED encounter (even if initiated at time of discharge); and studies not written in English.

The initial electronic database search yielded 3,842 unique titles and abstracts. After applying inclusion/exclusion criteria at various screening stages, we included 100 papers and abstracts in the final review. These studies, published between 2003 - 2023, predominantly originated from the US (66%). Using narrative synthesis, we summarized ED discharge intervention themes to form seven concept subgroups by consensus: mode of discharge; additional resource provision; addition of a discharge coordinator; follow-up assistance; pharmaceutical intervention; patient-centered education; and clinician/discharger-centered education. Effective strategies included enhanced discharge discussions and education by dedicated personnel, structured discharge checklists, and delivery of instructions at an appropriate reading level. However, because few studies have examined long-term patient-centered outcomes, such as ED return visits, hospitalizations, and mortality, cost-benefit analysis for interventions is lacking. Furthermore, the experiences of vulnerable populations who have limited-English proficiency are under-represented in current attempts to innovate ED discharge.

We found that interventions aimed at improving patient comprehension of discharge instructions were the most frequently studied and had the greatest impact on patient outcomes. This review highlights promising directions for patient-centered innovation; it also underscores the need for more research to optimize the adult ED discharge process and warrants a call to action.