JMIR Publications

ABSTRACT

Background:

The Dutch acute healthcare system faces challenges with limited resources and increasing patient numbers. To reduce outpatient follow-up, Direct Discharge (DD) has been implemented in over thirty out of 80 Dutch hospitals. With DD, no routine follow-up appointments are scheduled after the Emergency Department (ED) visit for low-complex, isolated, stable musculoskeletal injuries. This policy is supported by information leaflets, a smartphone application, and a telephone helpline with human support. Growing evidence shows that DD is satisfactory, safe, and effective in reducing secondary healthcare utilization, but thorough patient experiences are lacking.

Objective:

The aim of this study was to explore the experiences of patients with DD to ensure durable adoption and to improve the treatment protocol.

Methods:

A mixed-method study was conducted parallel to the implementation of DD in three hospitals. Data were collected through a survey directly after the ED visit, a survey three months post-injury, and semi-structured interviews. Quantitative data were reported descriptively, and qualitative data using thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptance, preliminary efficacy, and demand. All patients who consented to the study face-to-face with one of the twelve low-complex musculoskeletal injuries were included during the implementation period.

Results:

Of the 429 patients who started the primary survey, 138 completed both surveys. Eighteen semi-structured interviews were conducted and analyzed. Patients reported a median treatment satisfaction score of 7.8 (IQR 6.6 to 8.8) on a ten-point scale of DD at the ED. Information quality was experienced as good, and most preferred DD over face-to-face follow-up. Patient information demands and app use varied among patients, with a median frequency of use of 4 times (ranging from 1 to 30).

Conclusions:

This study shows that patients consider DD a feasible and safe alternative to traditional treatment, with a favorable perception of its acceptability, efficacy, applicability, and demand. Nevertheless, personal nuances and preferences must be considered when implementing DD. Clinicians, researchers, and policymakers can use the insights of this study to enhance the integration of DD into their clinical practice and future guidelines.