Nurse-involved hospital avoidance outreach interventions for aged care home residents: A mixed-method systematic review

Abstract

Older people residing in aged care homes often have complex health needs that can lead to hospitalisations, some of which are potentially avoidable. To address this, nurse-led or nurse-involved interventions have been implemented to reduce unnecessary hospital presentations. To review and synthesise evidence on the impact of nurse-led or nurse-involved hospital avoidance outreach interventions on health service use for aged care home residents. A mixed-methods systematic review guided by the Joanna Briggs Institute framework. Databases searched included Ovid Medline, Scopus, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). An initial search was conducted in October 2022 to identify peer-reviewed studies published in English between January 2011 to October 2022, with an update in August 2025. Titles, abstracts, and full text selections were screened by two or more independent reviewers and assessed for methodological quality. A convergent segregated approach was used for data synthesis and integration. Twenty-four studies met the inclusion criteria: 16 quantitative, seven qualitative and one mixed-method study. The majority were conducted in Australia (n = 21), with others in Finland, Denmark and France. Nurse-led or nurse-involved hospital avoidance interventions were associated with reductions in emergency department presentations, re-presentations and hospital admissions via the emergency department. Four studies reported cost savings, although findings were heterogeneous. Health professionals reported positive experiences, but the perspectives of aged care home residents and their families were underrepresented. Key enablers of intervention success included staff support, leadership, rapid response outreach interventions, technological infrastructure, and outreach team expertise. Operational barriers include inconsistent guidelines and policies, limited service hours, and challenges with technology implementation. This review highlights growing evidence base supporting nurse-led and nurse-involved outreach interventions to avoid hospitalisation for unwell aged care home residents. The enablers and barriers identified in this systematic review offer valuable insights for clinicians and researchers planning or refining hospital avoidance initiatives. The protocol for this systematic review was registered at the PROSPERO register on 31 December 2022 [CRD42022385659].