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Abstract
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 decision-making (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.
- outpatient discharge
- patient’s voice
- discharge decision-making
- discharge process
- patient's experience
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Footnotes
Contributors NAH carried out literature search, study design, data collection, data analysis, data interpretation and wrote the first draft of the manuscript. She was instrumental in getting ethical and R&D approval for the study. VP contributed to the study design, supervision of the project and writing of the manuscript. AYF and SS contributed to the study design, supervision of data collection, analysis of data and writing of the manuscript.
Funding NAH is funded by the University Malaya Medical Centre and The Council for Indigenous People of Malaysia (MARA). The funders had no role in the gathering or analysis of the data and no role in the writing of the manuscript or the decision to submit for publication.
Competing interests None declared.
Ethics approval South East Wales RECs Committee gave ethical approval. REC: 11/WSE03/4 Date approved: 24 February 2011. The participants gave informed consent before taking part in the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.