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Salentijn DA, Willinge GJA, Dijkgraaf MGW, van Veen RN. The impact on time between injury and semi-acute surgery for hand fractures after virtual fracture clinic implementation. J Hand Surg Eur Vol 2024:17531934241268976. [PMID: 39169756 DOI: 10.1177/17531934241268976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
The aim of this before-and-after study was to evaluate the implementation of a virtual fracture clinic (VFC) on the time between injury and surgery in patients presenting with a phalangeal or metacarpal fracture and in need of semi-acute surgical treatment. Between 1 January and 30 September 2018 (pre-VFC) and in the same period in 2022 (VFC), 101 and 113 patients were included, respectively. Before VCF implementation, the time between injury and surgery was 8.9 days (95% confidence interval [CI]: 8.1 to 9.6), while after VCF implementation it was 7.6 days (95% CI: 7.0 to 8.3). In 2018, 7% of operations were unacceptably delayed beyond 14 days from injury, which was reduced to 5% in 2022, despite patient-presentation delays of up to 10 days. VFC implementation was associated with a reduction in time until semi-acute surgery for phalangeal or metacarpal fractures and improved the quality of semi-acute surgery planning.Level of evidence: Level III.
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Affiliation(s)
- Dorien A Salentijn
- Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | | | - Marcel G W Dijkgraaf
- Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands
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Truter P, Pelletier I, Coates S, Giglia-Smith L, Richards K, Mountain D, Bulsara C, Spilsbury K, Edgar DW. Is clinician reported practice in Western Australian emergency departments aligned with direct discharge pathway protocols for minor self-limiting fractures? A multi-centre professional survey. Emerg Med Australas 2024. [PMID: 39090806 DOI: 10.1111/1742-6723.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To determine ED clinician's current management for five common minor self-limiting fractures (MSLF) and evaluate practice against evidence-informed direct discharge pathway (DD) protocols. METHODS A survey was provided to doctors, nurse practitioners and advanced scope physiotherapists working in seven metropolitan, public health EDs in Perth, Australia. The relative odds of ED location (e.g. which facility) and clinician level factors (e.g. country of initial training, years of ED experience, profession) on recommending care completely consistent with evidence informed direct discharge pathway protocols were estimated. RESULTS Two hundred sixty-two clinicians completed the survey. There was variability in practice across all sites, with most reported care assessed at 60%-76% consistency with individual elements of DD care provision. Highest consistency was seen in lower limb immobilisation and DVT prophylaxis. Lowest consistency was seen in weight bearing advice, pain management and (boxer's) fracture reduction and immobilisation. There were very low levels of complete consistency, ranging from 9% (boxer's fracture) to 25% (radial head fracture). Two factors were associated with increased odds of completely consistent care: (i) clinician experience working in ED, with greater duration of practice associated with increased odds ratios (OR range, 1.6-3.3); and (ii) profession, where advanced scope physiotherapy was associated with increased odds ratios (OR range, 3.2-25.0). CONCLUSIONS Survey results suggested system wide variation in ED fracture management practice and target areas for service improvement. Avenues for service improvement could include hospital wide agreed management plans for specific fractures and support for less experienced clinicians.
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Affiliation(s)
- Piers Truter
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Rockingham Hospital, Perth, Western Australia, Australia
| | - Irene Pelletier
- Emergency Department, Joondalup Health Campus, Perth, Western Australia, Australia
| | - Sophie Coates
- Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Louise Giglia-Smith
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Karen Richards
- Physiotherapy Department, SJOG Midland Public and Private Hospital, Perth, Western Australia, Australia
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - David Mountain
- Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Curtin University Medical School, Perth, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Katrina Spilsbury
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Dale W Edgar
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Discipline of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
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Kelly M, Donovan RL, Dailiana ZH, Pape HC, Chana-Rodríguez F, Pari C, Ponsen KJ, Cattaneo S, Belluati A, Contini A, Gómez-Vallejo J, Casallo-Cerezo M, Willinge GJ, van Veen RN, Gosling JC, Papadakis SA, Iliopoulos E. Rehabilitation after musculoskeletal injury: European perspective. OTA Int 2024; 7:e330. [PMID: 39114372 PMCID: PMC11301633 DOI: 10.1097/oi9.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 08/10/2024]
Abstract
Trauma is one of the main causes of death in younger people and ongoing disability worldwide. In Europe, while there is generally good organization of trauma reception and acute treatment, rehabilitation from major musculoskeletal injuries is less well defined and provided. This article documents the diverse approaches to rehabilitation after major injury in 6 European nations. The recognition of need is universal, but achieving a robust rehabilitation strategy is more elusive across the varying health care systems. Switzerland has the most robust service in the insured population. In the other countries, particularly where there is a reliance on public institutes, this provision is at best patchy. In the Netherlands, innovative patient-empowering strategies have gained traction with notable success, and in the United Kingdom, a recent randomized trial also showed this approach to be reproducible and robust. Overall, there is a clear need for learning across the national systems and implementation of a minimum set of standards.
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Willinge GJA, Spierings JF, Geerdink TH, Twigt BA, Goslings JC, van Veen RN. The effects of a Virtual Fracture Care review protocol on secondary healthcare utilization in trauma patients requiring semi-acute surgery: a retrospective cohort study. Front Digit Health 2024; 6:1362503. [PMID: 38952744 PMCID: PMC11215198 DOI: 10.3389/fdgth.2024.1362503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/21/2024] [Indexed: 07/03/2024] Open
Abstract
Purpose The demand for trauma care in the Netherlands is increasing due to a rising incidence of injuries. To provide adequate trauma care amidst this increasing pressure, a Virtual Fracture Care (VFC) review protocol was introduced for treatment of musculoskeletal injuries to the extremities (MIE). This study aimed to assess the influence of the Dutch VFC review protocol on secondary healthcare utilization (i.e., follow-up appointments and imaging) in adult trauma patients (aged ≥18 years) who underwent semi-acute surgery (2-14 days after initial presentation) for MIE, compared to traditional workflows. We hypothesized utilization of VFC review would lead to reduced secondary healthcare utilization. Methods This retrospective cohort study assessed the influence of VFC review on secondary healthcare utilization in adult trauma patients (aged ≥18 years) who underwent semi-acute surgery for a MIE. Patients treated before VFC review and the COVID-19 pandemic, from 1st of July 2018 to 31st of December 2019, formed a pre-VFC group. Patients treated after VFC review implementation from January 1st 2021 to June 30th 2022, partially during and after the COVID-19 pandemic (including distancing measures), formed a VFC group. Outcomes were follow-up appointments, radiographic imaging, time to surgery, emergency department reattendances, and complications. The study was approved by the local ethical research committee approved this study (WO 23.073). Results In total, 2,682 patients were included, consisting of 1,277 pre-VFC patients, and 1,405 VFC patients. Following VFC review, the total number of follow-up appointments reduced by 21% and a shift from face-to-face towards telephone consultations occurred with 19% of follow-up appointments performed by telephone in the VFC group vs. 4% in the pre-VFC group. Additionally, VFC review resulted in a 7% reduction of radiographs, improved time scheduling of surgery, and a 56% reduction of emergency department reattendances. Registered complication rates remained similar. Conclusion The utilization of VFC review for management of adult patients with a MIE requiring semi-acute surgery improves efficiency compared to traditional workflows. It results in a 21% follow-up appointment reduction, a shift from face-to-face to remote delivery of care, fewer radiographs, improved time scheduling of surgery, and reduces emergency department reattendances by 56%.
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Affiliation(s)
| | - J. F. Spierings
- Department of Trauma Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - T. H. Geerdink
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, Netherlands
| | - B. A. Twigt
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, Netherlands
| | - J. C. Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, Netherlands
| | - R. N. van Veen
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, Netherlands
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Willinge GJA, Spierings JF, Weert T, Twigt BA, Goslings JC, van Veen RN. Efficiency of a virtual fracture care protocol in non-operative treatment of adult patients with a distal radial fracture. J Hand Surg Eur Vol 2024; 49:341-349. [PMID: 37458134 DOI: 10.1177/17531934231187830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
This study aimed to determine the effects of virtual fracture care (VFC) on secondary healthcare utilization in non-operative treatment of adult patients with a distal radial fracture. A retrospective cohort study was performed, including those who received non-operative treatment without VFC (pre-VFC) and with VFC (VFC). Outcomes included secondary healthcare utilization, calculated treatment costs, emergency department (ED) reattendances and complication rates. In total, 88 pre-VFC and 99 VFC patients were included. Pre-VFC patients had more follow-up appointments, with a median of 4 (IQR: 3) versus a median of 4 (IQR: 1) in VFC patients. In addition, 3% of follow-up appointments for pre-VFC patients were performed remotely compared to 18% for VFC patients. Complications and ED reattendances were comparable between groups. In this study, non-operative treatment of adult patients with a distal radial fracture through VFC reduced secondary healthcare utilization, with similar reported complication and ED reattendance rates compared with treatment without VFC.Level of evidence: III.
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Affiliation(s)
- Gijs J A Willinge
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Jelle F Spierings
- Department of Trauma Surgery, St. Antonius Hospital Utrecht, Nieuwegein, the Netherlands
| | - Ton Weert
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Bas A Twigt
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - Ruben N van Veen
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, the Netherlands
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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; 48:2135-2144. [PMID: 34997258 PMCID: PMC8741539 DOI: 10.1007/s00068-021-01835-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
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. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01835-5.
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Geerdink TH, Geerdink NJ, van Dongen JM, Haverlag R, Goslings JC, van Veen RN. Cost-effectiveness of direct discharge from the emergency department of patients with simple stable injuries in the Netherlands. Trauma Surg Acute Care Open 2021; 6:e000763. [PMID: 34722930 PMCID: PMC8549675 DOI: 10.1136/tsaco-2021-000763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/01/2021] [Indexed: 11/03/2022] Open
Abstract
Background Approximately one-third of musculoskeletal injuries are simple stable injuries (SSIs). Direct discharge (DD) from the emergency department (ED) of patients with SSIs reduces healthcare utilization, without compromising patient outcome and experience, when compared with "traditional" care with routine follow-up. This study aimed to determine the cost-effectiveness of DD compared with traditional care from a societal perspective. Methods Societal costs, including healthcare, work absenteeism, and travel costs, were calculated for patients with an SSI, 6 months before (pre-DD cohort) and after implementation of DD (DD cohort). The pre-DD cohort was treated according to local protocols. The DD cohort was treated using orthoses, discharge leaflet, smartphone application, and telephone helpline, without scheduling routine follow-up. Effect measures included generic health-related quality of life (HR-QoL; EuroQol Five-Dimensional Questionnaire); disease-specific HR-QoL (functional outcome, different validated questionnaires, converted to 0-100 scale); treatment satisfaction (Visual Analog Scale (VAS), 1-10); and pain (VAS, 1-10). All data were assessed using a 3-month postinjury survey and electronic patient records. Incremental cost-effectiveness ratios were calculated and uncertainty was assessed using bootstrapping techniques. Results Before DD, 144 of 348 participants completed the survey versus 153 of 371 patients thereafter. There were no statistically significant differences between the pre-DD cohort and the DD cohort for generic HR-QoL (0.03; 95% CI -0.01 to 0.08), disease-specific HR-QoL (4.4; 95% CI -1.1 to 9.9), pain (0.08; 95% CI -0.37 to 0.52) and treatment satisfaction (-0.16; 95% CI -0.53 to 0.21). Total societal costs were lowest in the DD cohort (-€822; 95% CI -€1719 to -€67), including healthcare costs (-€168; 95% CI -€205 to -€131) and absenteeism costs (-€645; 95% CI -€1535 to €100). The probability of DD being cost-effective was 0.98 at a willingness-to-pay of €0 for all effect measures, remaining high with increasing willingness-to-pay for generic HR-QoL, disease-specific HR-QoL, and pain, and decreasing with increasing willingness-to-pay for treatment satisfaction. Discussion DD from the ED of patients with SSI seems cost-effective from a societal perspective. Future studies should test generalizability in other healthcare systems and strengthen findings in larger injury-specific cohorts. Level of evidence II.
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Affiliation(s)
- Thijs H Geerdink
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Niek J Geerdink
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert Haverlag
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands
| | - J Carel Goslings
- Department of Trauma Surgery, OLVG, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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