DOI

10.21007/con.dnp.2025.0100

Faculty Advisor

Jacqueline Sharp, DNP, APRN, PMHNP-BC & Sharon Little, DNP, FNP-C, APRN

Document Type

Poster

Publication Date

Spring 4-2-2025

Disciplines

Behavioral Medicine | Emergency Medicine | Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Mental and Social Health | Nursing | Nursing Administration | Other Mental and Social Health | Psychiatric and Mental Health | Psychiatric and Mental Health Nursing | Psychiatry | Quality Improvement

Abstract

Background

Emergency mental health hospital readmissions present significant challenges to healthcare systems, often resulting in increased costs, prolonged hospital stays, and poor patient outcomes. Continuity of care through predischarge referrals to outpatient mental health services, psychosocial support, and community resources has been proposed as a strategy to reduce readmissions. However, the effectiveness of these interventions remains inconsistent across different populations and settings.

Objective

This scoping review aims to evaluate the effectiveness of predischarge referrals in reducing 30-day emergency mental health hospital readmissions, identify key components of successful programs, and assess the influence of demographic factors on readmission rates.

Methods

A systematic search of peer-reviewed literature from 2019 to 2024 was conducted using PubMed, PsycINFO, Elsevier, SCOPUS, and Web of Science. Studies focused on adult psychiatric patients (18 years and older) who received predischarge referrals before hospital discharge. The final synthesis included 10 studies comprising randomized controlled trials, cohort studies, and observational research. Data extraction emphasized referral interventions, patient demographics, follow-up adherence, and readmission outcomes.

Results

Findings suggest that predischarge referrals significantly reduce readmission rates, particularly when integrated with multidisciplinary coordination and structured follow-up. The most effective interventions included personalized discharge planning, risk assessment for high-readmission patients, and interdisciplinary collaboration between inpatient and outpatient care teams. However, barriers such as inadequate coordination between services and disparities in community mental health resources limited the efficacy of these programs. Socioeconomic status and age influenced outcomes, with lower-income patients and older adults benefiting more from structured predischarge interventions.

Implications for Nursing

The results of this scoping review illustrate the need for consistent continuation of care and the implementation of structured discharge processes to ensure patients emergently admitted for mental health needs are referred and connected to the appropriate outpatient mental health resources upon discharge. There is sufficient evidence that supports thorough coordination of care between hospitals and community-based outpatient mental health resources will significantly reduce the number of patients readmitted for emergency mental health needs or crisis within a 30-day period. Communication between the interdisciplinary team of inpatient and outpatient facilities is mandatory to improve patient quality of care, monitor patient adherence, and assess for and provide crisis interventions when warranted.

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