Apply psychology and education

doi:10.1136/bmj.39458.489861.3A

BMJ 2008;336:109-110 (19 January), doi:10.1136/bmj.39458.489861.3A

Letters

Reducing hospital admissions

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The first 150 words of the full text of this article appear below.

I am a full time, out of hours general practitioner. I admitpatients to hospital for two reasons.¹ Firstly, if my top differentialdiagnosis has a illness trajectory that might result in thepatient coming to harm if he or she is not admitted. Secondly,if the functional state of the patient is such that nursingcare is required. The decision to admit is made by me with allmy failings and lack of knowledge and experience. One GP’sabsolute admission is another’s telephone advice.

Much could be done to reduce admissions if all parties continuedto reflect on all admissions. I follow up many of my admissionsbut usually have to ring the patient and the relatives. Gettinginformation from hospitals is difficult, and they sometimeseven refuse on the basis of confidentiality. If admitting GPsregularly had constructive feedback of admissions, includingevents after admissions and outcomes, then . . . [Full text of this article]

Graeme Mackenzie, out of hours general practitioner

¹ North Cumbria

graeme@papmacks.co.uk