# Outpatient discharge management model: a strategy to promote continuity of care

## TL;DR

This paper proposes a model for outpatient discharge management to improve continuity of care for chronic conditions by enhancing communication and collaboration between healthcare levels.

## Contribution

The novel contribution is an outpatient discharge model emphasizing nurse coordination, communication, and collaborative practices in primary care.

## Key findings

- Eight categories and 22 subcategories supported the model's development.
- Nurses were designated as process coordinators to improve continuity.
- Collaborative practices and technological support were highlighted as essential.

## Abstract

to propose an outpatient discharge management model from specialized care to primary care to promote continuity of care for chronic conditions.

action research with a qualitative approach. Twenty-eight professionals, including physicians, nurses, and public administrators, participated. Data collection was carried out through participant observation, documentary research, semi-structured interviews, and workshops. The data were subjected to Creswell’s content analysis.

eight categories and 22 subcategories supported the creation of the outpatient discharge management model, emphasizing communication among levels of the healthcare network, designating the nurse as the process coordinator, and encouraging collaborative practices.

the study proposed an outpatient discharge management model focused on continuity of care, in addition to reinforcing the role of nurses, highlighting attention to communication, technological support and collaborative practices, reaffirming the importance of Primary Health Care as a care organizer.

propor modelo de gestão de alta ambulatorial da atenção especializada para a atenção primária para promover a continuidade do cuidado nas condições crônicas.

pesquisa-ação, com abordagem qualitativa. Participaram 28 profissionais, como médicos, enfermeiros e gestores públicos. Coleta de dados ocorreu pela observação participante, pesquisa documental, entrevistas semiestruturadas e oficinas. Os dados foram submetidos à análise de conteúdo proposta por Creswell.

oito categorias e 22 subcategorias ampararam a criação do modelo de gestão de alta ambulatorial, enfatizando a comunicação entre os níveis da Rede de Atenção à Saúde, designando o enfermeiro como coordenador do processo e incentivando práticas colaborativas.

o estudo propôs um modelo de gestão de alta ambulatorial voltado para a continuidade do cuidado, além de reforçar o papel do enfermeiro, destacar a atenção para a comunicação, suporte tecnológico e práticas colaborativas, reafirmando a importância da Atenção Primária à Saúde como ordenadora do cuidado.