The dermatology outpatient discharge decision: understanding a critical but neglected process

Abstract

Discharge from dermatology outpatients is a critical endpoint of patient care. Despite this, there has been very little research concerning the discharge process and factors influencing the discharge decision. To identify the factors influencing discharge decisions, articles from 1970 to April 2013 were searched in MEDLINE via Ovid, CINAHL, PROQUEST and Google Scholar using the keywords 'patient discharge', 'discharge decision', 'factors influencing discharge', 'clinical decision making', 'discharge decision making', 'process of discharge decision', 'outpatient', 'follow up', 'skin disease' and 'dermatology'. Only articles describing outpatient discharge decisions were included. Seventeen outpatient discharge articles were identified, 12 from the U.K. (seven dermatology) and five from the U.S.A., Canada, Australia and Taiwan (all nondermatology). The main influences on outpatient discharge identified were diagnosis and disease severity, clinician's level of experience and perception, patient's preferences, patient's behaviour and quality of life. These influences affected the clinician's judgement on discharge decisions both in appropriate and in inappropriate ways. Little is known concerning discharge decision making in dermatology. Given the central importance of such decisions in the appropriate care of patients and the efficient running of any dermatology service, greater understanding of the influences on discharge decision making is needed. It is therefore critical for dermatologists to be aware of these influences and to ensure that decisions are taken only in the best interests of patients. Further research is required to inform the training of dermatologists on how to take the most appropriate discharge decisions.

How to Train to Discharge a Dermatology Outpatient: A Review

“…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.…”

“…This paper does not present novel research findings, but encapsulates the educational and training issues arising from recent research [2][3][4][5] .…”

“…We have recently reviewed the literature [2] and reported dermatologists' views on influences on the outpatient discharge decision [3] and patients' views on being discharged [4] . We proposed a "traffic light" design dermatology outpatient discharge information checklist to ensure that the minimum information to take a quality discharge decision is available to the clinician [5] .…”

“…The 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.…”

“…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.…”