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Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up:a systematic review of the current literature
- Source :
- Geerdink, T H, Verbist, J, van Dongen, J M, Haverlag, R, van Veen, R N & Goslings, J C 2022, ' 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, vol. 48, no. 4, pp. 2589-2605 . https://doi.org/10.1007/s00068-021-01784-z
- Publication Year :
- 2022
-
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.
- Subjects :
- Adult
Fracture management
medicine.medical_specialty
Healthcare utilization
Future studies
Sports medicine
Population
MEDLINE
CINAHL
Cochrane Library
Critical Care and Intensive Care Medicine
Value-based healthcare
Direct discharge
SDG 3 - Good Health and Well-being
Humans
Medicine
Orthopedics and Sports Medicine
Child
education
education.field_of_study
business.industry
Emergency department
Patient Discharge
Fracture
Emergency Medicine
Physical therapy
Systematic review
Surgery
Emergency Service, Hospital
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Geerdink, T H, Verbist, J, van Dongen, J M, Haverlag, R, van Veen, R N & Goslings, J C 2022, ' 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, vol. 48, no. 4, pp. 2589-2605 . https://doi.org/10.1007/s00068-021-01784-z
- Accession number :
- edsair.doi.dedup.....2cd3f7840610d50e20284c0c2108339a