Effectiveness of Transitional Care Programs in Reducing Emergency Department Visits and Hospital Readmissions: An Overview of Systematic Reviews and Critical Synthesis

Abstract

Unplanned returns to acute care after discharge concentrate risk into a period of diffuse accountability, yet evaluations of transitional care usually count inpatient readmissions and omit emergency department (ED) revisits. This overview of systematic reviews, combined with a critical synthesis of the wider literature, examined whether structured transitional care programs reduce ED visits and readmissions among discharged adults, and which program attributes are associated with effect. Three recent syntheses reporting these outcomes were used: a network meta-analysis of 126 trials with 97,408 participants, a meta-analysis of nurse-led programs and a meta-analysis of multidisciplinary programs for complex care needs. Their estimates and certainty ratings were extracted as published without re-pooling, and their overlap and methodological features were appraised qualitatively. For ED visits, the nurse-led synthesis reported a relative risk of 0.63 (95% CI 0.49 to 0.81) with no heterogeneity and high certainty. Readmission effects were conditional: low-complexity programs reduced 30-day readmission in the network meta-analysis (odds ratio 0.78), medium-complexity programs were most effective at 90 days (0.64), programs with seven or more components performed worst, and no reliable nurse-led effect appeared when follow-up ended before twelve weeks. A bounded effectiveness model explains the divergence: uncertainty-driven ED revisits yield to one reliable contact, whereas trajectory-driven readmissions require sustained, simple and accountable programs operating within structural limits.