TY - JOUR
T1 - Understanding clinician influences and patient perspectives on outpatient discharge decisions
T2 - A qualitative study
AU - Harun, N. A.
AU - Finlay, A. Y.
AU - Piguet, V.
AU - Salek, S.
N1 - This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Objective: To observe the influences on clinicians when discharging patients, to explore patients' perspectives concerning their discharge or follow-up decision and to identify what patients think is important for clinicians to consider when taking a discharge decision. Design: Qualitative study involving observations of consultations and semistructured interviews with outpatients. Setting: National Health Service outpatient clinics at a university hospital secondary referral centre. Participants: 64 consultations were observed followed by 56 interviews with patients aged over 18 years. Main outcome measure: Analysis of patients' perspectives and expectations concerning whether or not they were discharged. Results: 25 types of influences were observed to be influencing the discharge decision process. All 31 discharged patients appeared to accept the clinicians' decision; however, 10 (22%) of those patients later expressed disappointment. Patients' discontent was due to perceived clinicians' uncertainty in diagnosis (patients mentioning=2), poor acceptance of the diagnosis (2), disease not 'cured' (4), differing perception on medical needs (2), lack of concern for job demands (1), felt uninvolved in the decisionmaking (4), feeling rushed (3), prolonged open appointment (2), pushed to seek private care due to healthcare budget constraints (2), language barrier (1) and not keen to continue follow-up with general practitioner (2). Patients were happy when there was certainty of the diagnosis (19), clear treatment plan (16), advised on treatment side effects (7), given a contact number if symptoms recurred (4), considering their travelling and job demands (3). Conclusions: This study highlights the importance of accurately perceiving patients' perspectives in ensuring the appropriateness of outpatient discharge. There was a disparity between patients' and clinicians' perception on what was an appropriate discharge. This included discrepancies concerning diagnostic certainties, private healthcare as an alternative, need for easy reaccess and choice of words surrounding discharge. Medical education should include handling these issues.
AB - Objective: To observe the influences on clinicians when discharging patients, to explore patients' perspectives concerning their discharge or follow-up decision and to identify what patients think is important for clinicians to consider when taking a discharge decision. Design: Qualitative study involving observations of consultations and semistructured interviews with outpatients. Setting: National Health Service outpatient clinics at a university hospital secondary referral centre. Participants: 64 consultations were observed followed by 56 interviews with patients aged over 18 years. Main outcome measure: Analysis of patients' perspectives and expectations concerning whether or not they were discharged. Results: 25 types of influences were observed to be influencing the discharge decision process. All 31 discharged patients appeared to accept the clinicians' decision; however, 10 (22%) of those patients later expressed disappointment. Patients' discontent was due to perceived clinicians' uncertainty in diagnosis (patients mentioning=2), poor acceptance of the diagnosis (2), disease not 'cured' (4), differing perception on medical needs (2), lack of concern for job demands (1), felt uninvolved in the decisionmaking (4), feeling rushed (3), prolonged open appointment (2), pushed to seek private care due to healthcare budget constraints (2), language barrier (1) and not keen to continue follow-up with general practitioner (2). Patients were happy when there was certainty of the diagnosis (19), clear treatment plan (16), advised on treatment side effects (7), given a contact number if symptoms recurred (4), considering their travelling and job demands (3). Conclusions: This study highlights the importance of accurately perceiving patients' perspectives in ensuring the appropriateness of outpatient discharge. There was a disparity between patients' and clinicians' perception on what was an appropriate discharge. This included discrepancies concerning diagnostic certainties, private healthcare as an alternative, need for easy reaccess and choice of words surrounding discharge. Medical education should include handling these issues.
UR - http://www.scopus.com/inward/record.url?scp=85014595340&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2015-010807
DO - 10.1136/bmjopen-2015-010807
M3 - Article
C2 - 28264822
AN - SCOPUS:85014595340
SN - 2044-6055
VL - 7
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e010807
ER -