{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T04:25:52Z","timestamp":1780547152810,"version":"3.54.1"},"reference-count":35,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,1,17]]},"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To observe the influences on clinicians when discharging patients, to explore patients' perspectives concerning their discharge or follow-up decision and to identify what patients think is important for clinicians to consider when taking a discharge decision.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Qualitative study involving observations of consultations and semistructured interviews with outpatients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>National Health Service outpatient clinics at a university hospital secondary referral centre.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>64 consultations were observed followed by 56 interviews with patients aged over 18\u2005years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measure<\/jats:title>\n                  <jats:p>Analysis of patients' perspectives and expectations concerning whether or not they were discharged.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>25 types of influences were observed to be influencing the discharge decision process. All 31 discharged patients appeared to accept the clinicians' decision; however, 10 (22%) of those patients later expressed disappointment. Patients' discontent was due to perceived clinicians' uncertainty in diagnosis (patients mentioning=2), poor acceptance of the diagnosis (2), disease not <jats:underline>\u2018<\/jats:underline>cured\u2019 (4), differing perception on medical needs (2), lack of concern for job demands (1), felt uninvolved in the decision-making (4), feeling rushed (3), prolonged open appointment (2), pushed to seek private care due to healthcare budget constraints (2), language barrier (1) and not keen to continue follow-up with general practitioner (2). Patients were happy when there was certainty of the diagnosis (19), clear treatment plan (16), advised on treatment side effects (7), given a contact number if symptoms recurred (4), considering their travelling and job demands (3).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study highlights the importance of accurately perceiving patients' perspectives in ensuring the appropriateness of outpatient discharge. There was a disparity between patients' and clinicians' perception on what was an appropriate discharge. This included discrepancies concerning diagnostic certainties, private healthcare as an alternative, need for easy reaccess and choice of words surrounding discharge. Medical education should include handling these issues.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-010807","type":"journal-article","created":{"date-parts":[[2017,3,6]],"date-time":"2017-03-06T20:40:26Z","timestamp":1488832826000},"page":"e010807","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Understanding clinician influences and patient perspectives on outpatient discharge decisions: a qualitative study"],"prefix":"10.1136","volume":"7","author":[{"given":"N A","family":"Harun","sequence":"first","affiliation":[{"name":"Division of Infection and Immunity, Department of Dermatology and Wound Healing, School of Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2143-1646","authenticated-orcid":false,"given":"A Y","family":"Finlay","sequence":"additional","affiliation":[{"name":"Division of Infection and Immunity, Department of Dermatology and Wound Healing, School of Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6079-4517","authenticated-orcid":false,"given":"V","family":"Piguet","sequence":"additional","affiliation":[{"name":"Division of Infection and Immunity, Department of Dermatology and Wound Healing, School of Medicine, Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Salek","sequence":"additional","affiliation":[{"name":"School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,3,6]]},"reference":[{"key":"2025101814170495000_7.3.e010807.1","unstructured":"Health & Social Care Information Centre (2013\u20132014). Hospital outpatient activity. Available from: http:\/\/www.hscic.gov.uk\/catalogue\/PUB16722 (accessed 25 Sep 2015)."},{"key":"2025101814170495000_7.3.e010807.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c7373"},{"key":"2025101814170495000_7.3.e010807.3","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/JDN.0000000000000086","article-title":"Teledermatology: virtual access to quality dermatology care and beyond","volume":"6","author":"Roman","year":"2014","journal-title":"J Dermatol Nurses Assoc"},{"key":"2025101814170495000_7.3.e010807.4","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1108\/09526861011050556","article-title":"Reducing unnecessary outpatient attendances","volume":"23","author":"Donnellan","year":"2010","journal-title":"Int J Healthcare Qual Assur"},{"key":"2025101814170495000_7.3.e010807.5","unstructured":"Roland M , McDonald R , Sibbald B , et al . Outpatient services and primary care: a scoping review of research into strategies for improving outpatient effectiveness and efficiency. Manchester: National Primary Care Research and Development Centre, 2006."},{"key":"2025101814170495000_7.3.e010807.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2006.07328.x"},{"key":"2025101814170495000_7.3.e010807.7","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1111\/bjd.12826","article-title":"The dermatology outpatient discharge decision: understanding a critical but neglected process","volume":"170","author":"Harun","year":"2014","journal-title":"Br J Dermatol"},{"key":"2025101814170495000_7.3.e010807.8","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/bjd.13946","article-title":"Appropriate and inappropriate influences on outpatient discharge decision-making in dermatology: a prospective qualitative study","volume":"173","author":"Harun","year":"2015","journal-title":"Br J Dermatol"},{"key":"2025101814170495000_7.3.e010807.9","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/14.1.29"},{"key":"2025101814170495000_7.3.e010807.10","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/j.1365-2133.2010.09868.x","article-title":"Nonclinical influences, beyond diagnosis and severity, on clinical decision-making in dermatology: understanding the gap between guidelines and practice","volume":"163","author":"Hajjaj","year":"2010","journal-title":"Br J Dermatol"},{"key":"2025101814170495000_7.3.e010807.11","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmh507"},{"key":"2025101814170495000_7.3.e010807.12","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1046\/j.1365-2753.2001.00284.x","article-title":"Rationality in medical decision-making: a review of the literature on doctors\u2019 decision-making biases","volume":"7","author":"Bornstein","year":"2008","journal-title":"J Eval Clin Pract"},{"key":"2025101814170495000_7.3.e010807.13","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1136\/bmj.315.7116.1138","article-title":"Patients\u2019 views on their discharge from follow-up in outpatient clinics: qualitative study","volume":"315","author":"Burkey","year":"1997","journal-title":"BMJ"},{"key":"2025101814170495000_7.3.e010807.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7402.1316"},{"key":"2025101814170495000_7.3.e010807.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-001165"},{"key":"2025101814170495000_7.3.e010807.16","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1159\/000320124","article-title":"Clinical decision-making in dermatology: observation of consultations and the patients\u2019 perspectives","volume":"221","author":"Hajjaj","year":"2010","journal-title":"Dermatol"},{"key":"2025101814170495000_7.3.e010807.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h375"},{"key":"2025101814170495000_7.3.e010807.18","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1001\/jama.2015.2569","article-title":"Art of discharge","volume":"313","author":"Ouyang","year":"2015","journal-title":"JAMA"},{"key":"2025101814170495000_7.3.e010807.19","unstructured":"BMA Patient Liaison Group. Hospital discharge: the patient, carer and doctor perspective. http:\/\/bma.org.uk\/news-views-analysis\/news\/2014\/february\/patient-and-doctor-partnership-comes-of-age (accessed 28 Nov 2014)."},{"key":"2025101814170495000_7.3.e010807.20","unstructured":"Silverman D . Interpreting qualitative data. 4th edn. London: Sage, 2011."},{"key":"2025101814170495000_7.3.e010807.21","unstructured":"Ritchie J , Lewis J , Nicholls CM , et al . Qualitative research practice: a guide for social science students and researchers. Sage, 2013."},{"key":"2025101814170495000_7.3.e010807.22","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025101814170495000_7.3.e010807.23","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-013-0023-3"},{"key":"2025101814170495000_7.3.e010807.24","doi-asserted-by":"publisher","DOI":"10.1136\/jme.2010.041988"},{"key":"2025101814170495000_7.3.e010807.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.02.001"},{"key":"2025101814170495000_7.3.e010807.26","unstructured":"Kahneman D . Thinking fast and slow.UK: Penguin Group, 2011:381\u20134."},{"key":"2025101814170495000_7.3.e010807.27","doi-asserted-by":"publisher","DOI":"10.1037\/a0016755"},{"key":"2025101814170495000_7.3.e010807.28","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2011.178"},{"key":"2025101814170495000_7.3.e010807.29","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2011.266"},{"key":"2025101814170495000_7.3.e010807.30","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.12968\/bjon.1996.5.17.1065","article-title":"Elderly patients\u2019 participation in discharge decision-making: 2","volume":"5","author":"Jewell","year":"1996","journal-title":"Br J Nurs"},{"key":"2025101814170495000_7.3.e010807.31","doi-asserted-by":"publisher","DOI":"10.5694\/mja14.00002"},{"key":"2025101814170495000_7.3.e010807.32","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1111\/bjd.12984","article-title":"Shared decision-making in dermatology: asking patients, \u201cWhat is important to you?\u201d","volume":"170","author":"Anstey","year":"2014","journal-title":"Br J Dermatol"},{"key":"2025101814170495000_7.3.e010807.33","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.24.2313"},{"key":"2025101814170495000_7.3.e010807.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7234.541"},{"key":"2025101814170495000_7.3.e010807.35","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/bjd.14650","article-title":"The development and clinical evaluation of a \u201cTraffic-light design\u201d dermatology outpatient discharge information checklist","volume":"175","author":"Harun","year":"2016","journal-title":"Br J Dermatol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2015-010807","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T21:17:14Z","timestamp":1760822234000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2015-010807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,3,6]]},"published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1136\/bmjopen-2015-010807"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2015-010807","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3]]}}}