A RANDOMIZED TRIAL OF IMMEDIATE DISCHARGE OF SURGICAL PATIENTS TO GENERAL-PRACTICE

Background This study compares, in clinical and economic terms, out-pa tients follow-up with immediate discharge to general practice of patie nts undergoing any one of 29 defined surgical procedures. Methods A ra ndomized controlled trial was undertaken in which patients recruited f rom two general surgery wards in Ninewells Hospital, Dundee, were rand omized to follow-up care in the out-patient clinic or in general pract ice. Outcome was measured as clinical effectiveness in terms of morbid ity and mortality; economic costs to the hospital compared with genera l practice; patient benefits and satisfaction; and General Practitione rs' (GPs') opinions of the system. Results A total of 455 patients wer e randomized to out-patient and 454 to general practice follow-up. The y were followed up for a minimum of six months. There were no differen ces in readmission rates, mean number of operations or mortality. The difference between the groups in the total health service costs was ve ry small (pounds 2.68 per patient more for those receiving out-patient follow-up). More of the general practice group preferred general prac tice care than the out-patient group preferred out-patient care (p = 0 .03). The patient's travel costs and travel and treatment time were gr eater for the out-patient group (pounds 27.99, 113 min) than for the g eneral practice group (pounds 24.90, 82 min). The GPs felt they had be en 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 in stituted, the time saved in an out-patient clinic session of 40 patien ts would be an estimated 54 minutes, enough to see three extra new pat ients. Conclusion General practice based follow-up care for this group of patients is as effective as, but less costly than out-patient 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 w ill depend on the use of the time freed by a reduction in follow-up ap pointments in the out-patient clinic.