Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons

Geerdink, Thijs H.; Uijterwijk, Bas; Meijer, Dennie; Sierevelt, Inger N.; Mallee, Wouter H.; Veen, Ruben N van; Goslings, J. C.; Haverlag, Robert; Collaborative, Traumaplatform Study

doi:10.1016/j.injury.2020.11.026

Cited by 8 publications

(10 citation statements)

References 25 publications

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“…Strengths of this study include that it assessed whether the effects of DD remain comparable within a larger cohort, as well as within another hospital that was not involved in the development of the concept, whereas sample sizes of the previous Dutch pilot study was relatively small (i.e., < 800 patients) and performed in a single center [ 7 , 8 ]. This indicates that the concept is scalable and this is an important step towards the adoption of DD as standard-of-care [ 17 ]. Furthermore, to account for the non-randomized nature of this study, all effect measures were adjusted for the patient’s propensity score using regression models, to prevent confounding by indication.…”

Section: Discussionmentioning

confidence: 99%

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

Geerdink

Spierings

Schuijt

et al. 2022

Eur J Trauma Emerg Surg

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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. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01835-5.

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Section: Discussionmentioning

confidence: 99%

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

Geerdink

Spierings

Schuijt

et al. 2022

Eur J Trauma Emerg Surg

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“…Fifty-nine articles met the inclusion criteria and were considered for the analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The excluded thirty-four papers were editorials, letters, duplicate entries, and articles with no discussion on telemedicine even in the full text ( Figure 1 ). The monthly contributions trend of the orthopaedic telemedicine-related articles is shown in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have found that a major proportion of orthopaedic injury patients visiting outpatient clinics and emergency rooms only require basic care and are discharged without the need for specialist consultation arising. 29 , 30 , 31 Telemedicine-based care saves both cost and time in managing such patients. Telemedicine has emerged as an effective screening tool to categorise patients who require virtual consultation only and those who require physical evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Direct discharge refers to the practice of discharging patients directly from the screening clinic without any expert consultation. 31 , 32 Geerdink et al. 31 advocated for a direct discharge approach via virtual fracture clinics where simple-stable injuries were discharged directly and managed with self-assisted splints or braces and phone-based health care.…”

Section: Discussionmentioning

confidence: 99%

“… 31 , 32 Geerdink et al. 31 advocated for a direct discharge approach via virtual fracture clinics where simple-stable injuries were discharged directly and managed with self-assisted splints or braces and phone-based health care.…”

Section: Discussionmentioning

confidence: 99%

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Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

Kumar

Sinha

Jameel

et al. 2022

Journal of Taibah University Medical Sciences

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Objectives In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. Methods We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and qualitative review. Results Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. Conclusion Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.

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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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Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons

Cited by 8 publications

References 25 publications

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

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

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

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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