Appropriate and inappropriate influences on outpatient discharge decision making in dermatology: a prospective qualitative study. (25th August 2015)

• Record Type: Journal Article
• Authors: Harun, N.A.; Finlay, A.Y.; Salek, M.S.; Piguet, V.
• Is Part Of: British journal of dermatology. Volume 173:Number 3(2015:Sep.)
• Page Start: 720
• Page End: 730
• Publication Date: 2015-08-25
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.13946
• Languages: English
• ISSNs: 0007-0963

Abstract

<abstract abstract-type="main" id="bjd13946-abs-0001"> <title>Summary</title> <sec id="bjd13946-sec-0001" sec-type="section"> <title>Background</title> <p>Outpatient discharge decision making in dermatology is poorly understood.</p> </sec> <sec id="bjd13946-sec-0002" sec-type="section"> <title>Objective</title> <p>To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics.</p> </sec> <sec id="bjd13946-sec-0003" sec-type="section"> <title>Methods</title> <p>Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed.</p> </sec> <sec id="bjd13946-sec-0004" sec-type="section"> <title>Results</title> <p>The mean age of the clinicians was 48·8 years (range 33·0–67·0), 17 (43%) were men and 19 (48%) had > 20 years of clinical experience. One hundred and forty‐eight influences were reported, with five main themes: (i) disease‐based influences included type of diagnosis (100% of clinicians), guidelines (100%) and treatment needed (100%); (ii) clinician‐based influences included the clinician's level of experience (100%), seniority (37%), emotional attitude (95%), 'gut feeling' (25%), personal attitude towards discharge (45%) and level of perception (100%); (iii) patient‐based influences included patients' ability to cope with their disease (100%), wishes (70%), quality of life (32%), command of English (40%) and cultural background (25%); (iv) practice‐based influences included good primary care (100%), secondary support structure (100%) and clinic capacity pressure (67%); (v) policy‐based influences included pressure from hospital managers (57%) and an active discharge policy (7%). Fourteen (9%) influences were potentially inappropriate.</p> </sec> <sec id="bjd13946-sec-0005" sec-type="section"> <title>Conclusion</title> <p>This study has identified multiple factors influencing outpatient discharge decision making. This provides the basis for developing evidence‐based training to improve discharge decision appropriateness.</p> </sec> </abstract>