Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times, provider satisfaction and provider workload

Selvig, Daniel; Sewell, Justin L.; Tuot, Delphine S.; Day, Lukejohn W.

doi:10.1186/s12913-017-2819-6

Cited by 2 publications

(5 citation statements)

References 12 publications

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“…However, none of these patients had been transitioned to primary care, likely due to a lack of explicit communication between providers and between providers and patients regarding the possibility of transitioning. Another 2018 study 20 was conducted at a city‐wide health network, in which network gastroenterologists and primary care providers had implemented guidelines in 2013 for discharging postendoscopy patients back to primary care. The study's objective was to assess the impact of the implemented policy on gastroenterology clinic access, workflow, and provider satisfaction.…”

Section: Introductionmentioning

confidence: 99%

“…Another 2018 study 20 was conducted at a city-wide health network, in which network gastroenterologists and primary care providers had implemented guidelines in 2013 for discharging postendoscopy patients back to primary care. The study's objective was to assess the impact of the implemented policy on gastroenterology clinic access, workflow, and provider satisfaction.…”

Section: Introductionmentioning

confidence: 99%

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Care transitions from the specialty to the primary care setting: A scoping literature review of potential barriers and facilitators with implications for mental health care

Kim

Benzer

Afable

et al. 2023

Evaluation Clinical Practice

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Background, Aims and ObjectivesThis scoping review aimed to understand potential barriers and facilitators in transitioning patients from specialty to primary care settings, to inform the implementation of an intervention to promote active consideration of psychiatrically stable patients for transition from the specialty mental health setting back to primary care.MethodsGuided by Levac and colleagues' six‐stage methodological framework for conducting scoping studies, we systematically searched electronic article databases for peer‐reviewed literature from January 2000 to May 2016. We included identified articles that discuss findings related to potential barriers and facilitators in transitioning patients from specialty to primary care settings. We performed descriptive and thematic analyses of results to generate emergent codes and their categorizations.ResultsOur database search yielded 906 unique articles, 23 of which we included in our scoping review. All but one of the included studies were conducted in North America. Identified potential barriers and facilitators spanned eight emergent themes—(i) primary care accessibility, especially in terms of timely availability of appointments, (ii) clarity in respective roles of specialty care and primary care in managing a patient, (iii) timely exchange of information, (iv) transition process management, (v) perceived ability of primary care providers to manage specialty conditions, (vi) perceived ability of patients to self‐manage, (vii) leadership support and (viii) support for implementing initiatives to promote transitions.ConclusionsFindings from this scoping review enable an increased understanding of current practices and considerations regarding care transitions from specialty to primary care settings. The importance of role clarification, shared clinical information systems, confidence in care competency, and adequate organizational support to promote appropriate transitions were themes most widely reported across the reviewed studies. Few studies specifically examined the transition from specialty mental health to primary care. Future studies should account for mental health‐specific symptomatic patterns and recovery trajectories, such as prevalent chronicity and frequency of relapse, in planning and conducting transitions from specialty mental health back to primary care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Care transitions from the specialty to the primary care setting: A scoping literature review of potential barriers and facilitators with implications for mental health care

Kim

Benzer

Afable

et al. 2023

Evaluation Clinical Practice

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“…It has been argued that the traditional model of hospital specialist outpatient care may no longer be fit-for-purpose and places unnecessary financial and time costs on patients, clinicians, and the health system [2,3]. Discharging patients from hospital outpatient clinics to general practice when they can be safely managed in primary care improves access to specialist outpatient clinics [4,5]. Timely discharge is critical to ensure appropriate use of specialist services, streamline patient flow, and facilitate continuation of care in the community [6].…”

Section: Introductionmentioning

confidence: 99%

“…A proportion of hospital outpatient visits are for routine and preventive care which could be performed in primary care to enable hospitals to adapt and respond to more complex cases [12,13]. Implementing patientfocused discharge criteria reduces the number of unnecessary outpatient follow-up appointments, improves wait times and allows hospital specialists to use their expertise more efficiently [4,14]. Often patients are seen by their general practitioner several times in between hospital outpatient visits, and it has been argued that there is a significant amount of duplication of care occurring.…”

Section: Introductionmentioning

confidence: 99%

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Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: an interpretive approach

Kruys,

2023

BMC Health Serv Res

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Background Unnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting times. The aim of this study was to gain better understanding of hospital doctors’ and general practitioners’ perspectives of the barriers and facilitators when discharging from hospital outpatients to general practice. Methods An interpretative approach incorporating semi-structured interviews with 15 participants enabled both hospital doctors and general practitioners to give their perspectives on hospital outpatient discharge processes. Results Participants mentioned various system problems hampering discharge from hospital outpatient clinics to general practice, such as limitations of electronic communication tools, workforce and workload challenges, the absence of agreed discharge principles, and lack of benchmark data. Hospital clinicians may keep patients under their care out of a concern about lack of follow-up and an inability to escalate timely hospital care following discharge. Some hospital clinicians may have a personal preference to provide ongoing care in the outpatient setting. Other factors mentioned were insufficient supervision of junior doctors, a patient preference to remain under hospital care, and the ease of scheduling follow-up appointments. An effective handover process requires protected time, a systematic approach, and a supportive clinical environment including user-friendly electronic communication and clinical handover tools. Several system improvements and models of care were suggested, such as agreed discharge processes, co-designed between hospitals and general practice. Recording and sharing outpatient discharge data may assist to inform and motivate hospital clinicians and support the training of junior doctors. General practitioners participating in the study were prepared to provide continuation of care but require timely clinical management plans that can be applied in the community setting. A hospital re-entry pathway providing rapid access to outpatient hospital resources after discharge could act as a safety net and may be an alternative to the standard 12-month review in hospital outpatient clinics. Conclusion Our study supports the barriers to discharge as mentioned in the literature and adds the perspectives of both hospital clinicians and general practitioners. Potential solutions were suggested including co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge.

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Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times, provider satisfaction and provider workload

Cited by 2 publications

References 12 publications

Care transitions from the specialty to the primary care setting: A scoping literature review of potential barriers and facilitators with implications for mental health care

Care transitions from the specialty to the primary care setting: A scoping literature review of potential barriers and facilitators with implications for mental health care

Hospital doctors’ and general practitioners’ perspectives of outpatient discharge processes in Australia: an interpretive approach

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