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Published VersionCC BY V4.0, Open Access
Journal article
Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: An interpretive approach
BMC Health Services Research, Vol.23, pp.1-11
2023
Abstract
Background:
Unnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting times. The aim of this study was to gain better understanding of hospital doctors’ and general practitioners’ perspectives of the barriers and facilitators when discharging from hospital outpatients to general practice.
Methods:
An interpretative approach incorporating semi-structured interviews with 15 participants enabled both hospital doctors and general practitioners to give their perspectives on hospital outpatient discharge processes.
Results:
Participants mentioned various system problems hampering discharge from hospital outpatient clinics to general practice, such as limitations of electronic communication tools, workforce and workload challenges, the absence of agreed discharge principles, and lack of benchmark data. Hospital clinicians may keep patients under their care out of a concern about lack of follow-up and an inability to escalate timely hospital care following discharge. Some hospital clinicians may have a personal preference to provide ongoing care in the outpatient setting. Other factors mentioned were insufficient supervision of junior doctors, a patient preference to remain under hospital care, and the ease of scheduling follow-up appointments.
An effective handover process requires protected time, a systematic approach, and a supportive clinical environment including user-friendly electronic communication and clinical handover tools. Several system improvements and models of care were suggested, such as agreed discharge processes, co-designed between hospitals and general practice. Recording and sharing outpatient discharge data may assist to inform and motivate hospital clinicians and support the training of junior doctors.
General practitioners participating in the study were prepared to provide continuation of care but require timely clinical management plans that can be applied in the community setting. A hospital re-entry pathway providing rapid access to outpatient hospital resources after discharge could act as a safety net and may be an alternative to the standard 12-month review in hospital outpatient clinics.
Conclusion:
Our study supports the barriers to discharge as mentioned in the literature and adds the perspectives of both hospital clinicians and general practitioners. Potential solutions were suggested including co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge.
Details
- Title
- Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: An interpretive approach
- Authors
- Edwin Kruys (Author) - Sunshine Coast Hospital and Health ServiceChiung-Jung Wu (Corresponding Author) - University of the Sunshine Coast, Queensland, School of Health - Nursing
- Publication details
- BMC Health Services Research, Vol.23, pp.1-11
- Publisher
- BioMed Central Ltd.
- Date published
- 2023
- DOI
- 10.1186/s12913-023-10221-3
- ISSN
- 1472-6963
- Copyright note
- This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
- Data Availability
- Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
- Grant note
- This study was funded by the Wishlist and Study Education Research Trust Found (SERTF) Collaborative Research Grant (Wishlist/SERTF ID number: 2020–18). The funder did not play any role in the conduction or publication of the study.
- Organisation Unit
- School of Health - Nursing
- Language
- English
- Record Identifier
- 99971188202621
- Output Type
- Journal article
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