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Geerdink TH, Spierings JF, Schuijt HJ, et al. Healthcare utilization and satisfaction with treatment before and after direct discharge from the Emergency Department of simple stable musculoskeletal injuries in the Netherlands. Eur J Trauma Emerg Surg. 2022;doi: 10.1007/s00068-021-01835-5.
Geerdink, T. H., Spierings, J. F., Schuijt, H. J., Eversdijk, H. A. J., van Dongen, J. M., Kokke, M. C., Twigt, B. A., Goslings, J. C., & van Veen, R. N. (2022). Healthcare utilization and satisfaction with treatment before and after direct discharge from the Emergency Department of simple stable musculoskeletal injuries in the Netherlands. European journal of trauma and emergency surgery : official publication of the European Trauma Society, . https://doi.org/10.1007/s00068-021-01835-5
Geerdink, Thijs H, et al. "Healthcare utilization and satisfaction with treatment before and after direct discharge from the Emergency Department of simple stable musculoskeletal injuries in the Netherlands." European journal of trauma and emergency surgery : official publication of the European Trauma Society vol. (2022). doi: https://doi.org/10.1007/s00068-021-01835-5
Geerdink TH, Spierings JF, Schuijt HJ, Eversdijk HAJ, van Dongen JM, Kokke MC, Twigt BA, Goslings JC, van Veen RN. Healthcare utilization and satisfaction with treatment before and after direct discharge from the Emergency Department of simple stable musculoskeletal injuries in the Netherlands. Eur J Trauma Emerg Surg. 2022 Jan 08; doi: 10.1007/s00068-021-01835-5. Epub 2022 Jan 08. PMID: 34997258.
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Eur J Trauma Emerg Surg. 2022 Jan 08; doi: 10.1007/s00068-021-01835-5. Epub 2022 Jan 08.

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

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

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

Affiliations

  1. Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. [email protected].
  2. Department of Trauma Surgery, Sint Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands.
  3. Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
  4. Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.

PMID: 34997258 DOI: 10.1007/s00068-021-01835-5

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.

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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

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