Description:
<jats:title>Accessible Summary</jats:title><jats:sec><jats:title>What is known on the subject?</jats:title><jats:p>
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<jats:list-item><jats:p>The period between hospital discharge and community reintegration is a vulnerable time for people with mental illness due to a lack of continuity of care. They are at a high risk of undesired outcomes, including return to hospital.</jats:p></jats:list-item>
<jats:list-item><jats:p>Many transitional models have been developed. It is important to continue evaluating models for improvement and adaptability to different contexts.</jats:p></jats:list-item>
<jats:list-item><jats:p>The transitional discharge model (<jats:styled-content style="fixed-case">TDM</jats:styled-content>) is an intervention that incorporates both continued support from hospital staff after discharge and peer support to facilitate a smooth transition. Previous studies have reported positive outcomes such as increased discharges, decreased readmissions, reduced inpatient length of stay and improved quality of life.</jats:p></jats:list-item>
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</jats:p></jats:sec><jats:sec><jats:title>What the paper adds to existing knowledge?</jats:title><jats:p>
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<jats:list-item><jats:p>Health service use outcomes were examined separately for acute and tertiary care psychiatric units. Previous <jats:styled-content style="fixed-case">TDM</jats:styled-content> studies in Canada only examined tertiary care units, but many patients also receive care in acute care units.</jats:p></jats:list-item>
<jats:list-item><jats:p>Although recent studies of different interventions generally reported decreased readmissions, the current study found readmissions increased after <jats:styled-content style="fixed-case">TDM</jats:styled-content> and then decreased over time for acute care units, whereas no change was observed for tertiary care units. </jats:p></jats:list-item>
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</jats:p></jats:sec><jats:sec><jats:title>What are the implications for practice?</jats:title><jats:p>
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<jats:list-item><jats:p>Transitional discharge model evidence supports nursing practice based on interpersonal relations and strategies. Nurses need to be aware of peer support resources to facilitate this part of the model.</jats:p></jats:list-item>
<jats:list-item><jats:p>The effectiveness of <jats:styled-content style="fixed-case">TDM</jats:styled-content> may be increased by considering the differences in needs of distinct patient groups, such as those discharged from acute versus tertiary care units.</jats:p></jats:list-item>
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</jats:p></jats:sec><jats:sec><jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>The transitional discharge model (<jats:styled-content style="fixed-case">TDM</jats:styled-content>) bridges hospital discharge and community living for people receiving psychiatric services. <jats:styled-content style="fixed-case">TDM</jats:styled-content>, based on Peplau's theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers and formal peer support.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To compare temporal trends in psychiatric health services use before and after <jats:styled-content style="fixed-case">TDM</jats:styled-content> implementation within acute and tertiary care psychiatric units in Ontario, Canada.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Using health administrative databases, monthly discharges from psychiatric units 3 years prior to 2 years after <jats:styled-content style="fixed-case">TDM</jats:styled-content> implementation were identified. Median inpatient length of stay (<jats:styled-content style="fixed-case">LOS</jats:styled-content>), psychiatric readmission rates and mental health‐related emergency department visit rates were compared using segmented regression analyses.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among acute care units, median <jats:styled-content style="fixed-case">LOS</jats:styled-content> decreased significantly below the projected historical trend following <jats:styled-content style="fixed-case">TDM</jats:styled-content> implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>Studies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and staff practices.</jats:p></jats:sec><jats:sec><jats:title>Implications for Practice</jats:title><jats:p>Needs of people from different unit types should be considered when implementing <jats:styled-content style="fixed-case">TDM</jats:styled-content>. Nurses should recognize the development of therapeutic relationships and availability of peer support resources.</jats:p></jats:sec></jats:sec>