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. 2022 Jun;48(3):2135-2144.
doi: 10.1007/s00068-021-01835-5. Epub 2022 Jan 8.

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

Thijs H Geerdink  1 , Jelle F Spierings  2 , Henk Jan Schuijt  2 , Hubert A J Eversdijk  2 , Johanna M van Dongen  3 , Marike C Kokke  2 , Bas A Twigt  4 , J Carel Goslings  4 , Ruben N van Veen  4
Affiliations

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

Thijs H Geerdink et al. Eur J Trauma Emerg Surg. 2022 Jun.

Abstract

Purpose: To evaluate healthcare utilization and satisfaction with treatment before and after implementing direct discharge (DD) from the Emergency Department (ED) of patients with simple, stable musculoskeletal injuries.

Methods: Patients with simple, stable musculoskeletal injuries were included in two Dutch hospitals, both level-2 trauma centers: OLVG and Sint Antonius (SA), before (pre-DD-cohort) and after implementing DD (DD-cohort). With DD, no routine follow-up appointments are scheduled after the ED visit, supported by information leaflets, a smartphone application and a telephone helpline. Outcomes included: secondary healthcare utilization (follow-up appointments and X-ray/CT/MRI); satisfaction with treatment (scale 1-10); primary healthcare utilization (general practitioner (GP) or physiotherapist visited, yes/no). Linear regression was used to compare secondary healthcare utilization for all patients and per injury subgroup. Satisfaction and primary healthcare utilization were analyzed descriptively.

Results: A total of 2033 (OLVG = 1686; SA = 347) and 1616 (OLVG = 1396; SA = 220) patients were included in the pre-DD-cohort and DD-cohort, respectively. After DD, the mean number of follow-up appointments per patient reduced by 1.06 (1.13-0.99; p < 0.001) in OLVG and 1.07 (1.02-0.93; p < 0.001) in SA. Follow-up appointments reduced significantly for all injury subgroups. Mean number of follow-up X-rays per patient reduced by 0.17 in OLVG (p < 0.001) and 0.18 in SA (p < 0.001). Numbers of CT/MRI scans were low and comparable. In OLVG, mean satisfaction with treatment was 8.1 (pre-DD-cohort) versus 7.95 (DD-cohort), versus 7.75 in SA (DD-cohort only). In OLVG, 23.6% of pre-DD-cohort patients visited their GP, versus 26.1% in the DD-cohort, versus 13.3% in SA (DD-cohort only). Physiotherapist use was comparable.

Conclusion: This study performed in a large population and additional hospital confirms earlier pilot results, i.e., that DD has the potential to effectively reduce healthcare utilization, while maintaining high levels of satisfaction.

Level of evidence: II.

Keywords: Direct discharge; Emergency Department; Fracture; Healthcare utilization; Virtual fracture clinic.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: apart from the unrestricted grant, the authors have nothing to declare; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Inclusion periods of both cohorts in the different centers, to assess healthcare utilization and satisfaction. DD Direct discharge, loc location
Fig. 2
Fig. 2
Depiction of number and flow of the patients included per hospital and outcome type. DD Direct discharge, loc location
Fig. 3
Fig. 3
Infographic providing a summary of the results of this study. Patients were included in two hospitals before and after changing treatment protocols for eleven types of simple, stable musculoskeletal injuries. After treatment protocols were changed, patients with these injuries were no longer followed-up routinely, but discharged directly from the Emergency Department instead using self-removable orthoses and an available telephone helpline in case of questions or concerns. In Sint Antonius hospital, the pre-DD-cohort was included retrospectively and consequently, it was not possible to assess primary healthcare utilization and satisfaction with treatment. DD Direct discharge, ED Emergency Department, GP General Practitioner, loc. location
See this image and copyright information in PMC

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