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Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons
- Source :
- Injury, 52(4), 774-779. Elsevier Limited
- Publication Year :
- 2020
-
Abstract
- Introduction The importance of routine follow-up of several relatively simple stable injuries (SSIs) is questionable. Multiple studies show that direct discharge (DD) of patients with SSIs from the Emergency Department results in patient outcomes and experiences comparable to ‘standard care’ with outpatient follow-up. The purpose of this study was to evaluate to which extent DD of SSIs has been adopted amongst trauma and orthopedic surgeons internationally, and to assess the variation in the management of these common injuries. Methods An online survey was sent to members of an international trauma- and orthopaedic surgery collaboration. Participants, all trauma- or orthopaedic surgeons, were presented with eleven hypothetical cases of patients with simple stable injuries in which they were asked to outline their treatment plan regarding number of follow-up appointments and radiographs, physiotherapy and when to start functional movement. The primary outcome was the proportion of surgeons selecting direct discharge (i.e. zero scheduled appointments), per injury. Secondary outcomes included clinical agreement (>80% of respondents answering similarly) on total number of follow-up appointments (0, 1 or ≥2), radiographs (0, 1 or ≥2), routine physiotherapy referral (yes/no) and when to start functional movement (weeks). Results 138 of 667 (20.7%) surgeons completed the survey. Adoption of direct discharge ranged from 4-45% of case examples. In 10 out of 11 cases, less than 25% of surgeons selected direct discharge. Clinical agreement regarding number of appointments and when to start functional movement was not reached for any of the injuries. There was clinical agreement on number of radiographs for one injury and for four injuries regarding routine referral to a physiotherapist. Discussion Despite available evidence, DD of SSIs has not been widely adopted worldwide. Practice variation still exists even for these common injuries. This variation suggests inefficiency and consequently unnecessarily high healthcare costs. (Orthopaedic) trauma surgeons are encouraged to evaluate their current treatment protocols of SSIs.
- Subjects :
- medicine.medical_specialty
Virtual fracture clinic
Referral
Direct discharge
03 medical and health sciences
0302 clinical medicine
Clinical Protocols
Treatment plan
Surveys and Questionnaires
Health care
medicine
Humans
In patient
Practice variation
Orthopaedic trauma
Functional movement
General Environmental Science
030222 orthopedics
Simple stable injuries
Emergency department
business.industry
030208 emergency & critical care medicine
Cost-effective
Orthopedic Surgeons
Patient Discharge
Fracture
Orthopedics
Orthopedic surgery
Fracture, Cost-effective
Physical therapy
General Earth and Planetary Sciences
business
Subjects
Details
- ISSN :
- 18790267 and 00201383
- Volume :
- 52
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Injury
- Accession number :
- edsair.doi.dedup.....bee54a2e8b3c855d7dffb6efb9c34da3