How to Train to Discharge a Dermatology Outpatient: A Review

Abstract

skills, avoiding decision biases and encouraging good interprofessional collaboration. Training should include the consideration of the possibility of discharge at each consultation. Novel training strategies have been developed on how to appropriately manage the outpatient discharge process, including involving and informing patients. These strategies focus on safe decision-making, being patient-centred and organizing an efficient health care service framework. Conclusion: Structured outpatient discharge training for dermatologists is now possible, based on information from detailed doctor-and patient-based qualitative studies. © 2017 S. Karger AG, Basel IntroductionThe decision whether or not to discharge an outpatient has major implications for the quality of patient care and efficiency of outpatient services [1][2][3][4][5] . This is particularly important in the primarily outpatient specialty of dermatology, where very large numbers of patients are seen, and delayed discharge of patients has a major impact on service efficiency. Both patients and the health service can be adversely affected by inappropriately early outpatient discharge and conversely by inappropriate follow-up appointments. Keywords Education · Discharge decision · Dermatology outpatients · Clinical practiceAbstract Background/Aims: The decision to discharge is a critical and common outpatient consultation event. However, little guidance exists over how discharge decision-making can be taught. We aimed to provide educational recommendations concerning outpatient discharge decision-making. Methods: Recommendations were drawn from prior interviews with 40 consultant dermatologists and 56 dermatology outpatients, and from the "traffic light" design discharge information checklist, developed using the Delphi technique. Results: The key strategies to follow to appropriately manage the outpatient discharge process are: to warn patients in advance, to understand patients' agendas, to allow extra time for the discharge process, to prepare patients to self-manage, to provide a "safety net" and provide the GP with a clear management plan. Aspects to be considered include patient mobility, presence of carer, type of employment, diagnostic certainty, and use of the checklist or guidelines. Key training aspects include teaching structured thought processes when discharging, discharging according to context, developing communication and negotiation Most clinicians have never been taught how to discharge an outpatient, and most trainees receive no discharge training [2] . Despite outpatient discharge being one of the commonest decisions taken by clinicians there has been very little research aimed at understanding it. Training on how to discharge is essential to ensure that appropriate decisions are made in the best interests of the patient. Training is also necessary because of long waiting lists for outpatient specialist care [6,7] , uncertainties over how to make discharge decisions [8,9] , patients' lack of understanding of discharge instructions [10,...