Appropriate and inappropriate influences on outpatient discharge decision making in dermatology: a prospective qualitative study

N A Harun, A Y Finlay, M S Salek, V Piguet

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)
11 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)720-30
Number of pages11
JournalBritish Journal of Dermatology
Issue number3
Publication statusPublished - 1 Sept 2015


  • 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


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