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Appropriate and inappropriate influences on outpatient discharge decision making in dermatology : a prospective qualitative study. / Harun, N A; Finlay, A Y; Salek, M S; Piguet, V.

In: British Journal of Dermatology, Vol. 173, No. 3, 25.09.2015, p. 720-30.

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@article{98094c50e4824e55856b3a62baf4cabd,
title = "Appropriate and inappropriate influences on outpatient discharge decision making in dermatology: a prospective qualitative study",
abstract = "BACKGROUND: Outpatient discharge decision making in dermatology is poorly understood.OBJECTIVE: To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics.METHODS: Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed.RESULTS: 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.CONCLUSION: 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.",
keywords = "Adult, Aged, Ambulatory Care/standards, Attitude of Health Personnel, Clinical Competence/standards, Clinical Decision-Making/methods, Consultants, Dermatology/standards, England, Female, Humans, Male, Medical Staff, Hospital/standards, Middle Aged, Patient Discharge/standards, Prospective Studies, Skin Diseases/therapy",
author = "Harun, {N A} and Finlay, {A Y} and Salek, {M S} and V Piguet",
note = "{\circledC} 2015 British Association of Dermatologists",
year = "2015",
month = "9",
day = "25",
doi = "10.1111/bjd.13946",
language = "English",
volume = "173",
pages = "720--30",
journal = "British Journal of Dermatology",
issn = "0007-0963",
publisher = "Wiley-Blackwell",
number = "3",

}

RIS

TY - JOUR

T1 - Appropriate and inappropriate influences on outpatient discharge decision making in dermatology

T2 - a prospective qualitative study

AU - Harun, N A

AU - Finlay, A Y

AU - Salek, M S

AU - Piguet, V

N1 - © 2015 British Association of Dermatologists

PY - 2015/9/25

Y1 - 2015/9/25

N2 - BACKGROUND: Outpatient discharge decision making in dermatology is poorly understood.OBJECTIVE: To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics.METHODS: Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed.RESULTS: 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.CONCLUSION: 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.

AB - BACKGROUND: Outpatient discharge decision making in dermatology is poorly understood.OBJECTIVE: To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics.METHODS: Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed.RESULTS: 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.CONCLUSION: 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.

KW - Adult

KW - Aged

KW - Ambulatory Care/standards

KW - Attitude of Health Personnel

KW - Clinical Competence/standards

KW - Clinical Decision-Making/methods

KW - Consultants

KW - Dermatology/standards

KW - England

KW - Female

KW - Humans

KW - Male

KW - Medical Staff, Hospital/standards

KW - Middle Aged

KW - Patient Discharge/standards

KW - Prospective Studies

KW - Skin Diseases/therapy

U2 - 10.1111/bjd.13946

DO - 10.1111/bjd.13946

M3 - Article

VL - 173

SP - 720

EP - 730

JO - British Journal of Dermatology

JF - British Journal of Dermatology

SN - 0007-0963

IS - 3

ER -