primary care
Remove discharge from the list of outcomes to improve health outcomes
Think about this? There is only one speciality where the patient isn’t discharged from the doctor’s care. The answer is general practice. Yet in most clinical jobs, the all important discharge, is the most important outcome.
Once the patient has left then it’s not my problem: until the next time.
There is tentative evidence that Patient outcomes can be improved, if after discharge to home, they are visited by the doctor who treated them in hospital in the first place.
Yet, it’s slightly confusing, although communication between Primary care docs and hospital docs was found to be pretty poor at the time of discharge. There’ no surprise in that. In one study it made no difference in terms of adverse outcomes, if the communication was good or bad.
In addition to this, many patients leave hospital with test results pending and doctors are often unaware of important actions once the patient has gone home.
Even simple things can make a difference: The risk of being admitted to hospital decreases when patients are seen after discharge by a clinician who has actually received the discharge summary. Common sense at its best.
A lot of people want to know how to save healthcare costs and reform the health service. Then the answer has to be: ask simple questions and think simple answers. If everyone in healthcare stopped seeing discharge as the outcome we’d be a lot better off.

See Carl Heneghan in action in the CEBM's workshop videos. 
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