title: Appropriate and inappropriate influences on outpatient discharge decision making in dermatology: a prospective qualitative study.
abstract: BACKGROUND
  Outpatient discharge decision making in dermatology is poorly understood.
  
  
  OBJECTIVE
  To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics.
  
  
  METHODS
  Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed.
  
  
  RESULTS
  The mean age of the clinicians was 48.8 years (range 33.0-67.0), 17 (43%) were men and 19 (48%) had > 20 years of clinical experience. One hundred and forty-eight influences were reported, with five main themes: (i) disease-based influences included type of diagnosis (100% of clinicians), guidelines (100%) and treatment needed (100%); (ii) clinician-based influences included the clinician's level of experience (100%), seniority (37%), emotional attitude (95%), 'gut feeling' (25%), personal attitude towards discharge (45%) and level of perception (100%); (iii) patient-based influences included patients' ability to cope with their disease (100%), wishes (70%), quality of life (32%), command of English (40%) and cultural background (25%); (iv) practice-based influences included good primary care (100%), secondary support structure (100%) and clinic capacity pressure (67%); (v) policy-based influences included pressure from hospital managers (57%) and an active discharge policy (7%). Fourteen (9%) influences were potentially inappropriate.
  
  
  CONCLUSIONS
  This study has identified multiple factors influencing outpatient discharge decision making. This provides the basis for developing evidence-based training to improve discharge decision appropriateness.
authors.affiliation: Department of Dermatology and Wound Healing, Institute of Infection and Immunity, School of Medicine, Cardiff University, 3rd Floor, Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K.|Department of Dermatology, University Malaya Medical Centre, Kuala Lumpur, 50603, Malaysia.
authors.forename: N A
authors.initials: NA
authors.lastname: Harun
authors.affiliation: Department of Dermatology and Wound Healing, Institute of Infection and Immunity, School of Medicine, Cardiff University, 3rd Floor, Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K.
authors.forename: A Y
authors.initials: AY
authors.lastname: Finlay
authors.affiliation: School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, U.K.
authors.forename: M S
authors.initials: MS
authors.lastname: Salek
authors.affiliation: Department of Dermatology and Wound Healing, Institute of Infection and Immunity, School of Medicine, Cardiff University, 3rd Floor, Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K.
authors.forename: V
authors.initials: V
authors.lastname: Piguet
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D000066491:Clinical Decision-Making / Q000379:methods*; D003253:Consultants; D003880:Dermatology / Q000592:standards*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards*; D011446:Prospective Studies; D012871:Skin Diseases / Q000628:therapy