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

Autor: Geerdink TH; Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. t.h.geerdink@olvg.nl., Spierings JF; Department of Trauma Surgery, Sint Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands., Schuijt HJ; Department of Trauma Surgery, Sint Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands., Eversdijk HAJ; Department of Trauma Surgery, Sint Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands., van Dongen JM; Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences Research Institute, Vrije Universiteit, Amsterdam, The Netherlands., Kokke MC; Department of Trauma Surgery, Sint Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands., Twigt BA; Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands., Goslings JC; Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands., van Veen RN; Department of Trauma Surgery, OLVG Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2022 Jun; Vol. 48 (3), pp. 2135-2144. Date of Electronic Publication: 2022 Jan 08.
DOI: 10.1007/s00068-021-01835-5
Abstrakt: 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.)
Databáze: MEDLINE
Externí odkaz: