Hospital physicians’ views on discharge and readmission processes: a qualitative study from Norway

OBJECTIVES: To explore hospital physicians’ views on readmission and discharge processes in the interface between hospitals and municipalities. DESIGN: Qualitative case study. SETTING: The Norwegian healthcare system. PARTICIPANTS: Fifteen hospital physicians (residents and consultants) from one hospital, involved in the treatment and discharge of patients. RESULTS: The results of this study showed that patients were being discharged earlier, with more complex medical conditions, than they had been previously, and that discharges sometimes were perceived as premature. Insufficient capacity at the hospital resulted in pressure to discharge patients, but the primary healthcare service of the area was not always able to assume care of these patients. Communication between levels of the healthcare service was limited. The hospital stay summary was the most important, and sometimes only, form of communication between levels. The discharge process was described as complicated and was affected by healthcare personnel, by patients themselves and by aspects of the primary healthcare service. Early hospital discharges, poor communication between healthcare services and inadequacies in the discharge process were perceived to affect hospital readmissions. CONCLUSION: The results of this study provide a better understanding of hospital physicians’ views on the discharge and hospital readmission processes in the interface between the hospital and the primary healthcare service. The study also identifies discrepancies in governmental requirements, reform regulations and current practices in municipalities and hospitals.