Healthcare utilization and satisfaction with treatment before and after direct discharge from the Emergency Department of simple stable musculoskeletal injuries in the Netherlands

Geerdink, Thijs H.; Spierings, Jelle Friso; Schuijt, Henk Jan; Eversdijk, Hubert A J; Dongen, Johanna M. van; Kokke, M.C.; Twigt, Bas A; Goslings, J. Carel; Veen, Ruben N van

doi:10.1007/s00068-021-01835-5

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…Most health care professionals considered DD a safe alternative to face-to-face follow-up, leading to a perceived reduction of SHU. This finding is consistent with previous articles, which concluded that DD is safe based on low, comparable complication numbers, with significantly reduced SHU compared to traditional treatment [9,18,33]. The perceived reduction in SHU varied among stakeholders.…”

Section: Comparison With Existing Literaturesupporting

confidence: 90%

“…The DD protocol involves discharging patients from the emergency department (ED) without scheduled follow-up while providing patients with information through a self-care mobile eHealth app. DD significantly reduces secondary health care use (SHU) with similar levels of patient satisfaction and primary health care use (PHU) [9][10][11]. Based on these results and catalyzed by the COVID-19 pandemic, over 25 Dutch hospitals have implemented this protocol since 2019 [12].…”

Section: Introductionmentioning

confidence: 99%

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Health Care Professionals’ Experiences With a Mobile Self-Care Solution for Low Complex Orthopedic Injuries: Mixed Methods Study

Spierings,

Willinge,

Kokke

et al. 2024

JMIR Mhealth Uhealth

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Background To cope with the rising number of patients with trauma in an already constrained Dutch health care system, Direct Discharge (DD) has been introduced in over 25 hospitals in the Netherlands since 2019. With DD, no routine follow-up appointments are scheduled after the emergency department (ED) visit, and patients are supported through information leaflets, a smartphone app, and a telephone helpline. DD reduces secondary health care use, with comparable patient satisfaction and primary health care use. Currently, little is known about the experiences of in-hospital health care professionals with DD. Objective The aim of this study was to explore the experiences of health care professionals with the DD protocol to enhance durable adoption and improve the protocol. Methods We conducted a mixed methods study parallel to the implementation of DD in 3 hospitals. Data were collected through a preimplementation survey, a postimplementation survey, and semistructured interviews. Quantitative data were reported descriptively, and qualitative data were reported using thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptability, preliminary efficacy, demand, and applicability. Preimplementation expectations were compared with postimplementation experiences. Health care professionals involved in the daily clinical care of patients with low-complex, stable injuries were eligible for this study. Results Of the 217 eligible health care professionals, 128 started the primary survey, 37 completed both surveys (response rate of 17%), and 15 participated in semistructured interviews. Health care professionals expressed satisfaction with the DD protocol (median 7.8, IQR 6.8-8.9) on a 10-point scale, with 82% (30/37) of participants noting improved information quality and uniformity and 73% (27/37) of patients perceiving reduced outpatient follow-up and imaging. DD was perceived as safe by 79% (28/37) of participants in its current form, but a feedback system to reassure health care professionals that patients had recovered adequately was suggested to improve DD. The introduction of DD had varying effects on workload and job satisfaction among different occupations. Health care professionals expressed intentions to continue using DD due to increased efficiency, patient empowerment, and self-management. Conclusions Health care professionals perceive DD as an acceptable, applicable, safe, and efficacious alternative to traditional treatment. A numerical in-app feedback system (eg, in-app communication tools or recovery scores) could alleviate health care professionals’ concerns about adequate recovery and further improve DD protocols. DD can reduce health care use, which is important in times of constrained resources. Nonetheless, both advantages and disadvantages should be considered while evaluating this type of treatment. In the future, clinicians and policy makers can use these insights to further optimize and implement DD in clinical practice and guidelines.

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Section: Comparison With Existing Literaturesupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Health Care Professionals’ Experiences With a Mobile Self-Care Solution for Low Complex Orthopedic Injuries: Mixed Methods Study

Spierings,

Willinge,

Kokke

et al. 2024

JMIR Mhealth Uhealth

Self Cite

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“…22 Moreover, in a previous Dutch cohort study it was shown that the direct discharge of simple, stable musculoskeletal injuries from the ED is feasible. 23 Our findings support the idea that the low-acuity nature of the Further research is needed to evaluate this alternate clinical pathway and its effect on patient care, missed injury rates and ED crowding.…”

Section: Discussionsupporting

confidence: 78%

“…This was illustrated during the COVID‐19 pandemic, in which a considerable number of Dutch EDs redirected patients with minor traumatic injuries to outpatient departments 22 . Moreover, in a previous Dutch cohort study it was shown that the direct discharge of simple, stable musculoskeletal injuries from the ED is feasible 23 …”

Section: Discussionmentioning

confidence: 99%

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Primary care access to radiology: Characteristics of trauma patients referred to the emergency department

Kusters

Peters

Osch

et al. 2022

Evaluation Clinical Practice

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Rationale, Aims and Objectives Low‐urgent Emergency Department (ED) attendances are a known contributing factor to ED crowding. In the Netherlands, general practitioners (GPs) have direct access to radiology facilities during office hours. Patients with radiographically confirmed traumatic injuries are subsequently referred to the ED. We analysed these ED trauma patients' characteristics, provided treatments and ED discharge diagnoses to identify the possibility of alternative care pathways. Methods Single‐centre retrospective observational study of trauma patients referred to the ED by the radiology department during office hours (January 2017–December 2017). Data were obtained from patient records. Descriptive statistics were used to analyse the extracted data. Results A total of 662 patients were included. The median age was 42 years (range: 1–100, interquartile range (IQR): 15–63) and patients presented to the ED with a median delay of 1 day (range: 0–112 days, IQR: 0–5). Most patients were referred for injuries involving the upper extremities (61.5%) and lower extremities (30%). A total of 48 additional diagnoses were made in the ED. The majority of injuries was classified as ‘minor’ (29.5%) or ‘moderate’ (68.3%) on the Abbreviated Injury Scale (AIS). The median length of stay in the ED was 65 min (range: 7–297 min, IQR: 43–102). Conclusion Most patients presented with low acuity injuries and often with a notable delay to the ED. This suggests that the majority of these patients do not necessarily need ED treatment, which may provide an opportunity to counter ED crowding.

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Direct discharge for children with a greenstick or torus fracture of the wrist is a non-inferior satisfactory solution to traditional treatment

Spierings,

Willinge,

Schuijt

et al. 2024

Eur J Trauma Emerg Surg

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Purpose Direct Discharge protocols (DD) can alleviate strain on healthcare systems by reducing routine outpatient follow-up. These protocols include low-complex musculoskeletal injuries, such as isolated greenstick fractures or torus fractures of the wrist in children. While there is consensus on the effectiveness of DD, there is a lack of injury-specific powered studies. This study compares treatment satisfaction between DD and traditional treatment in children with a greenstick fracture or torus fractures of the wrist. Methods Children with isolated torus or greenstick fractures of the distal radius or ulna were eligible for inclusion before (pre-DD cohort) and after (DD cohort) the implementation of DD in four hospitals. Traditionally, patients receive a (soft) cast and minimally one routine outpatient follow-up appointment. With DD, patients are discharged directly from the ED after receiving a brace and information, summarized in a smartphone app and a helpline for questions during recovery. The primary outcome was patient or proxy treatment satisfaction (0 to 10), and a power analysis was performed to assess non-inferiority. Secondary outcomes included complications, functional outcomes measured in Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE), primary healthcare utilisation, and secondary healthcare utilisation (follow-up appointments and imaging). Results In total, 274 consecutive children were included to analyse the primary endpoint. Of these, 160 (58%) were male with a median age of 11 years (IQR 8 to 12). Pre-DD and DD treatment satisfaction did not vary statistically significantly for greenstick fractures (p = 0.09) and torus fractures (p = 0.93). No complications were observed. PROMIS UE showed no statistically significant differences before and after implementation of direct discharge protocol for torus (p = 0.99) or greenstick (p = 0.45) fractures. Secondary healthcare utilisation regarding follow-up was significantly lower in the DD-torus cohort compared to the pre-DD torus cohort, with a mean difference (MD) of − 1.00 follow-up appointments (95% Confidence Interval (CI) − 0.92 to − 1.13). Similar results were found in the pre DD-greenstick cohort compared to the pre-DD-greenstick cohort (MD): − 1.17 follow-up appointments, 95% CI − 1.09 to − 1.26). Conclusion Direct Discharge is non-inferior to traditional treatment in terms of treatment satisfaction for paediatric patients with greenstick or torus fractures of the wrist compared to children treated with rigid immobilisation and routine follow-up. Furthermore, the results demonstrate no complications, comparable functional outcomes, and a statistically significant reduction of secondary healthcare utilisation, making DD a good solution to cope with strained resources for children with an isolated greenstick fracture or torus fracture of the wrist.

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Healthcare utilization and satisfaction with treatment before and after direct discharge from the Emergency Department of simple stable musculoskeletal injuries in the Netherlands

Cited by 8 publications

References 8 publications

Health Care Professionals’ Experiences With a Mobile Self-Care Solution for Low Complex Orthopedic Injuries: Mixed Methods Study

Health Care Professionals’ Experiences With a Mobile Self-Care Solution for Low Complex Orthopedic Injuries: Mixed Methods Study

Primary care access to radiology: Characteristics of trauma patients referred to the emergency department

Direct discharge for children with a greenstick or torus fracture of the wrist is a non-inferior satisfactory solution to traditional treatment

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