Supporting discharge preparation for children with medical complexity: a scoping review

The transition from hospital to home is a critical period for children with medical complexity (CMC) and their caregivers, often associated with increased risks and stress. Both registered nurses and advanced practice nurses play a pivotal role in facilitating this transition through discharge preparation, including planning, coordination, and teaching. However, best practices for optimizing discharge processes for CMC remain unclear. The need for a comprehensive understanding of hospital discharge during this crucial time is apparent as adverse events following discharge are common and are often attributed to insufficient preparation and communication. This scoping review aims to identify key nursing and health care provider interventions that enhance discharge preparation for CMC, highlighting effective strategies and gaps in current practices.

Guided by Arksey and O'Malley's (2005) framework and using Covidence, we conducted a comprehensive review of literature on discharge interventions for CMC, focusing on studies on nursing-led strategies, caregiver readiness, and post-discharge outcomes. The following databases were searched in March 2023: CINAHL, EMBASE, and Ovid MEDLINE. The review was led by the National Pediatric Nurse Scientist Collaborative (NPNSC). Sessions for planning, data extraction, analysis, and manuscript preparation were conducted virtually.

This review included 27 studies (13 qualitative, 7 quantitative, 7 mixed-methods) from 2014-2023, primarily from the U.S. (70%). Sample sizes varied, with mothers most studied (30%). Only 9% examined nursing-specific interventions. Definitions of medical complexity and transition to home care were inconsistent, highlighting the need for standardized terminology and targeted discharge interventions.

Nurse-led interventions are essential for improving discharge readiness and post-discharge outcomes for CMC and their caregivers. Key findings reveal that effective discharge to home care interventions rely on child- and family(caregiver)-centric approaches, such as individualized care plans, caregiver education, and coordination across diverse care settings. Effectiveness of discharge interventions underscores the importance of tailored discharge processes. Additionally, mutual communication and decision-making and the development of caregiver competence are recurring themes that contribute to successful transitions. Future research should focus on standardizing best practices, incorporating caregiver perspectives, and developing holistic, nurse-led discharge models to enhance transition success. These efforts will support equitable, high-quality care for this vulnerable population.