Geerdink Thijs H, Haverlag Robert, van Veen Ruben N, Bouwmeester Olivier V A, Goslings J Carel
OLVG, afd. Traumachirurgie, Amsterdam.
Contact: Thijs H. Geerdink (
Ned Tijdschr Geneeskd. 2020 Feb 25;164:D4604.
To describe and study (a) the implementation of direct discharge from a Dutch Emergency Department (ED) for patients with relatively simple stable injuries (SSIs), (b) preliminary logistical and financial effects, and (c) patients' experiences.
Prospective cohort study.
Following the example of a healthcare reorganisation in the United Kingdom, in May 2019 we changed the treatment protocols of eleven SSIs. Since that time, no standard follow-up appointment has been scheduled for these patients. Patients are given information about treatment and the recovery period, and a form of immobilization is applied which can easily be removed at home. This information is summarised in a discharge leaflet and a smartphone application. A telephone helpline is available for any concerns or questions. During the implementation phase we determined compliance with, and deviation from, the protocol daily for 3 months. To determine the logistical and financial effects we compared the healthcare utilization of all patients with SSIs three months before and after implementation. Patient satisfaction and the shift in treatment towards primary care were determined by means of questionnaires.
In the three months before implementation 275 patients with an SSI presented to our ED, compared with 318 in the same period after implementation; 304 of the 318 patients were directly discharged (protocol compliance 95.6%). We found a significant reduction in follow-up appointments (-91%), radiological imaging (-72%), and costs. Patient satisfaction was comparable. There was no shift towards primary care in healthcare utilisation.
In the Netherlands, direct discharge from the ED seems to be an effective and safe alternative to traditional treatment with outpatient follow-up. Further studies on patient-reported outcomes should determine if this process is in concordance with the principle of Value Based Health Care.
描述并研究（a）荷兰急诊科对伤势相对简单稳定的患者实施直接出院的情况，（b）初步的后勤和财务影响，以及（c）患者的体验。
前瞻性队列研究。
以英国医疗重组为范例，2019年5月我们更改了11种简单稳定伤势（SSI）的治疗方案。自那时起，不再为这些患者安排标准的随访预约。向患者提供有关治疗和恢复期的信息，并采用一种在家中可轻松拆除的固定方式。这些信息总结在出院传单和智能手机应用程序中。设有电话热线，解答任何疑虑或问题。在实施阶段，我们连续3个月每天确定方案的依从性和偏差情况。为确定后勤和财务影响，我们比较了实施前后3个月所有SSI患者的医疗利用情况。通过问卷调查确定患者满意度以及向初级保健治疗的转变情况。
实施前3个月，有275名SSI患者到我们急诊科就诊，实施后同期为318名；318名患者中有304名直接出院（方案依从率95.6%）。我们发现随访预约（-91%）、影像学检查（-72%）和费用显著减少。患者满意度相当。医疗利用方面未出现向初级保健的转变。
在荷兰，急诊科直接出院似乎是传统门诊随访治疗的一种有效且安全的替代方案。关于患者报告结局的进一步研究应确定这一过程是否符合基于价值的医疗保健原则。
