Co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge could help improve current hospital outpatient discharge processes to general practice, researchers suggest.
Their study involving interviews with 15 doctors (nine hospital doctors representing seven specialties, six GPs) revealed that about 20-60% of hospital outpatients were receiving unnecessary appointments and could be managed in primary care.
The researchers, which included former RACGP vice president and former Queensland chair Dr Edwin Kruys, said GPs were prepared to provide continuation of care to these patients but required timely clinical management plans to do so.
One GP interviewed said: “I see a lot of outpatient appointments that seem unnecessary, because they’re monitoring things or they’re doing things that we could do as GP if we just received better communication from the hospital.”
Interviewees mentioned multiple system issues hindering discharge from hospital outpatient clinics, including limited electronic communication tools, workforce and workload challenges, and a lack of hospital benchmark data on discharge rates.
Hospital doctors indicated they kept patients under their care out of a concern about lack of follow‐up and an inability to escalate timely hospital care following discharge. Other factors mentioned were a patient preference to remain under hospital care and ease of scheduling follow‐up appointments once in the clinic.
There was also lack of trust in the capacity or skills of other clinicians in follow-up, according to the findings published in BMC Health Services Research [link here].
One specialist said: “There is always that element of, no one does it better than yourself – type thing, which is a bit of a weird thing but I know what I’m looking for so I should probably then follow it up.”
When patients were discharged, GPs complained that they did not always receive clinical handover correspondence and test results from the outpatient clinics, leaving them “trying to find out what’s happened” for most of the consultation.