Reducing Psychiatric Readmissions: EBP Literature Review
This literature review examines evidence-based practice (EBP) strategies for reducing short-cycle psychiatric hospital readmissions. Drawing on five peer-reviewed studies — including systematic reviews and a randomized controlled trial — the paper identifies key factors driving readmission rates, such as environmental conditions, length of stay, and the critical vulnerability window immediately following discharge. The review evaluates the Coleman Care Transitions Model as a framework for improving patient-provider communication, psychoeducation, medication management, and structured follow-up. Findings are applied to a PICOT-driven clinical question, with the goal of informing nursing practice changes that can free hospital beds, reduce costs, and improve patient outcomes.
- Introduction and Purpose: EBP goal to reduce psychiatric readmissions
- Search Process: Database search methods and keyword strategy
- Critical Appraisal and Study Selection: Study ranking by hierarchy of evidence
- Results of the Studies: Key findings from five selected studies
- Theoretical and Operational Application to the PICOT: Applying study findings to clinical practice
- Coleman Care Transitions Model: Four supports of the Coleman transition model
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What makes this paper effective
- The paper applies a clear hierarchy of evidence to rank selected studies, transparently explaining why each study was included and at what level of strength (Level 1 through Level 7).
- Each study's findings are immediately connected back to the PICOT question and the Coleman model, maintaining a tight link between evidence and practical application throughout.
- The paper identifies a clinically precise insight — the immediate post-discharge window as the highest-risk period — and uses it to prioritize intervention timing in a meaningful, actionable way.
Key academic technique demonstrated
This paper demonstrates systematic literature synthesis within an evidence-based practice framework. Rather than summarizing studies in isolation, the author cross-references findings to build a cumulative argument: environmental factors, effective transition components, contraindicated practices (compulsory supervision), and timing all converge to support adoption of the Coleman model. This technique shows how a literature review can function as an evidence base for clinical decision-making, not merely a descriptive summary.
Structure breakdown
The paper opens with the purpose of the EBP project, then methodically documents the search process and critical appraisal criteria before presenting individual study results. The final two sections synthesize findings theoretically and operationally, culminating in a description of the Coleman model's four key supports. This funnel structure — from broad search to specific practice recommendations — is characteristic of EBP literature reviews at the undergraduate nursing level.
Introduction and Purpose
The purpose of this evidence-based practice (EBP) project is to facilitate a strategy to eradicate short-cycle returns — that is, early readmissions — of psychiatric patients to hospital beds. Doing so will assist healthcare providers in addressing the issue of bed shortages. Reducing readmission rates creates more space for other patients, helps cut costs, and promotes better conformity with governmental regulations.
Search Process
The search process used in this literature review began with searching key terms in online databases such as the Cochrane Review, CINAHL, and other nursing research journal databases. Google Scholar was used as the primary search engine, with filters set to return results from these specific databases. Key terms included "reducing readmission rates," "readmission psych," "causes of readmission psych hospital," "psych hospital readmission," "reduction of psych readmission," and other keyword combinations identified through relevant articles found during initial searches.
More than a thousand articles were yielded across the various searches. These results were trimmed according to relevance and publication year, with only the most recent studies selected for final inclusion. Common keywords found in relevant articles were also used to conduct additional searches until a collection of fifteen articles was assembled. The hierarchy of evidence was then applied to select the strongest studies, including a systematic review and a randomized controlled trial. Articles not selected included case editorials and studies in which no clear conclusion was reached by the researchers.
References
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. DOI: 10.1016/S0140-6736(13)60107-5.
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.
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.
Tulloch, A., David, A., & Thornicroft, G. (2016). Exploring the predictors of early readmission to psychiatric hospital. Epidemiology and Psychiatric Sciences, 25(2): 181–193.
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.
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