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Exploring physicians' decision-making in hospital readmission processes - a comparative case study.

Malin Knutsen Glette1,2, Tone Kringeland3, Olav Røise4,5,6

  • 1Faculty of Health, Western Norway University of Applied Sciences, Haugesund, Norway. Malinknutsen.glette@hvl.no.

BMC Health Services Research
|September 21, 2018
PubMed
Summary
This summary is machine-generated.

Hospital readmissions among the elderly are complex. Poor communication and information flow significantly impact physician decisions, highlighting a need for improved care coordination in municipal healthcare.

Keywords:
Decision-makingHospital dischargeHospital readmissionsPatient handoversPatient safety

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Area of Science:

  • Healthcare Management
  • Geriatric Medicine
  • Health Services Research

Background:

  • Hospital readmissions pose significant risks, particularly for elderly patients.
  • A 2012 Norwegian healthcare reform incentivized early transfer to primary care, increasing the urgency of studying municipal readmissions.
  • General practitioners (GPs) and nursing home physicians act as key gatekeepers in hospital readmissions but their decision-making is under-researched.

Purpose of the Study:

  • To investigate factors contributing to hospital readmissions among elderly patients in municipal healthcare.
  • To specifically examine the decision-making processes of general practitioners (GPs) and nursing home physicians regarding hospital readmissions.

Main Methods:

  • Comparative case study design involving two municipalities with differing readmission rates.
  • Interviews with twenty general practitioners (GPs) and nursing home physicians from each municipality.
  • Observation of care coordination meetings (huddles) in nursing homes.

Main Results:

  • Seven themes emerged, detailing factors influencing physicians' readmission decisions.
  • Poor communication, continuity, and information flow were identified as key contributors to readmissions in both municipalities.
  • Physician decision-making was also influenced by nurse staffing, patient/family factors, time constraints, and experience.

Conclusions:

  • Communication, continuity, and information flow are critical factors in hospital readmissions.
  • Slight differences in influencing factors were noted between the two case municipalities.
  • Further research is recommended on physician decision-making, and the experiences of nursing and home care nurses.