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Geerdink TH, Verbist J, van Dongen JM, et al. Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature. Eur J Trauma Emerg Surg. 2021;doi: 10.1007/s00068-021-01784-z.
Geerdink, T. H., Verbist, J., van Dongen, J. M., Haverlag, R., van Veen, R. N., & Goslings, J. C. (2021). Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature. European journal of trauma and emergency surgery : official publication of the European Trauma Society, . https://doi.org/10.1007/s00068-021-01784-z
Geerdink, T H, et al. "Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature." European journal of trauma and emergency surgery : official publication of the European Trauma Society vol. (2021). doi: https://doi.org/10.1007/s00068-021-01784-z
Geerdink TH, Verbist J, van Dongen JM, Haverlag R, van Veen RN, Goslings JC. Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature. Eur J Trauma Emerg Surg. 2021 Sep 16; doi: 10.1007/s00068-021-01784-z. Epub 2021 Sep 16. PMID: 34529086.
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Eur J Trauma Emerg Surg. 2021 Sep 16; doi: 10.1007/s00068-021-01784-z. Epub 2021 Sep 16.

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature.

European journal of trauma and emergency surgery : official publication of the European Trauma Society

T H Geerdink, J Verbist, J M van Dongen, R Haverlag, R N van Veen, J C Goslings

Affiliations

  1. Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. [email protected].
  2. Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
  3. Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.

PMID: 34529086 DOI: 10.1007/s00068-021-01784-z

Abstract

PURPOSE: There is growing evidence that patients with certain simple stable musculoskeletal injuries can be discharged directly from the Emergency Department (ED), without compromising patient outcome and experience. This study aims to review the literature on the effects of direct discharge (DD) of simple stable musculoskeletal injuries, regarding healthcare utilization, costs, patient outcome and experience.

METHODS: A systematic review was performed in Medline, Embase, CINAHL, Cochrane Library and Web of Science using PRISMA guidelines. Comparative and non-comparative studies on DD of simple stable musculoskeletal injuries from the ED in an adult/paediatric/mixed population were included if reporting ≥ 1 of: (1) logistic outcomes: DD rate (proportion of patients discharged directly); number of follow-up appointments; DD return rate; (2) costs; (3) patient outcomes/experiences: functional outcome; treatment satisfaction; adverse outcomes; other.

RESULTS: Twenty-six studies were included (92% conducted in the UK). Seven studies (27%) assessed functional outcome, nine (35%) treatment satisfaction, and ten (38%) adverse outcomes. A large proportion of studies defined DD eligibility criteria as injuries being minor/simple/stable, without further detail. ED DD rate was 26.7-59.5%. Mean number of follow-up appointments was 1.00-2.08 pre-DD, vs. 0.00-0.33 post-DD. Return rate was 0.0-19.4%. Costs per patient were reduced by €69-€210 (ranging from - 38.0 to - 96.6%) post-DD. Functional outcome and treatment satisfaction levels were 'equal' or 'better' (comparative studies), and 'high' (non-comparative studies), post-DD. Adverse outcomes were low and comparable.

CONCLUSIONS: This systematic review supports the idea that DD of simple stable musculoskeletal injuries from the ED provides an opportunity to reduce healthcare utilization and costs without compromising patient outcomes/experiences. To improve comparability and facilitate implementation/external validation of DD, future studies should provide detailed DD eligibility criteria, and use a standard set of outcomes. Systematic review registration number: 120779, date of first registration: 12/02/2019.

© 2021. The Author(s).

Keywords: Direct discharge; Fracture; Fracture management; Healthcare utilization; Systematic review; Value-based healthcare

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