A randomized trial of immediate discharge of surgical patients to general practice

This study compares, in clinical and economic terms, out-patient follow-up with immediate discharge to general practice of patients undergoing any one of 29 defined surgical procedures.

A randomized controlled trial was undertaken in which patients recruited from two general surgery wards in Ninewells Hospital, Dundee, were randomized to follow-up care in the out-patient clinic or in general practice. Outcome was measured as clinical effectiveness in terms of morbidity and mortality; economic costs to the hospital compared with general practice; patient benefits and satisfaction; and General Practitioners' (GPs') opinions of the system.

A total of 455 patients were randomized to outpatient and 454 to general practice follow-up. They were followed up for a minimum of six months. There were no differences in readmission rates, mean number of operations or mortality. The difference between the groups in the total health service costs was very small (2.68 pounds per patient more for those receiving out-patient follow-up). More of the general practice group preferred general practice care than the out-patient group preferred out-patient care (p = 0.03). The patient's travel costs and travel and treatment time were greater for the out-patient group (27.99 pounds, 113 min) than for the general practice group (24.90 pounds, 82 min). The GPs felt they had been given adequate information in the discharge documentation and were willing to accept immediate discharge as normal policy, although they expected it to increase their workload. If immediate discharge were instituted, the time saved in an out-patient clinic session of 40 patients would be an estimated 54 minutes, enough to see three extra new patients.

General practice based follow-up care for this group of patients is as effective as, but less costly than outpatient care and is acceptable to GPs. Because of only small differences in costs between the two forms of follow-up, real gains to the health service will depend on the use of the time freed by a reduction in follow-up appointments in the out-patient clinic.