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.
Critical Appraisal and Study Selection
The critical appraisal process for this literature review included identifying the results of each study, assessing study validity, determining whether results would facilitate patient care, recognizing similarities between the study subjects and the patients who are the focus of this EBP, and evaluating whether the study was qualitative or quantitative in nature. Selected studies were then ranked according to strength using the hierarchy of evidence, with systematic reviews and meta-analyses ranking highest 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. DOI: 10.1016/S0140-6736(13)60107-5.
This study is a 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 is a systematic review and thus represents 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 also a systematic review and therefore sits at the highest level (Level 1) of the 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 is 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
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 analyzing the relationship between payment models and readmissions, and suggested that financing systems could be a major variable in readmission rates. This finding is applicable to the PICOT of the EBP because the Eric Coleman Care Transitions Model is based on the idea of utilizing services to ensure optimum communication and care for continual, safe, quality care during periods of transition, so that readmission does not become an issue. As this study indicates, environmental factors are unique in many cases and must be considered on a case-by-case basis. In other words, there is no one-size-fits-all approach to patient transitions: providers must assess each patient's needs individually in order to ensure a smooth transition and to mitigate the risk of readmission.
Vigod et al. (2013) found that "effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers, and inpatient/outpatient provider communication." These findings are applicable to the PICOT because they identify precise areas of focus that should be addressed by transition managers using the Coleman model to reduce the risk of readmission.
Burns et al. (2013) found that "compulsory supervision does not reduce the rate of readmission of psychotic patients" in their randomized controlled trial of 442 patients discharged from a hospital or community treatment order (CTO). This indicates that, within the PICOT framework, compulsory supervision is not an effective tool in the Coleman model. Better transition management is required — including outreach, education, and communication — but mandatory supervision imposed against the patient's will does not support mitigation of readmission risk.
Tulloch et al. (2016) found that the type of psychological impairment is a factor in early readmission, as is the length of stay in the hospital prior to discharge. The study also found that the high-risk window for readmission is the period "immediately subsequent to discharge." Therefore, with the PICOT in mind, the transition period that should receive the greatest focus from transition managers is that immediately after discharge, when patients are uncertain and may need additional guidance through communication with transition managers.
Kripalani et al. (2013) found that while compulsory supervision does not reduce readmission rates, "some multifaceted interventions have been successful in this regard." These multifaceted interventions include "having multiple components that span both inpatient and outpatient settings and delivery by dedicated transitional care personnel." Such interventions require considerable care, time, support, and resources and cannot succeed without a clear plan and a defined management team. For the PICOT, this means that the intervention must be clearly and succinctly defined, with roles and objectives delineated and appropriate resources allocated.
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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