Abstract
This thesis is centered around the Virtual Fracture Care (VFC) project, which was initiated in the OLVG hospital (Amsterdam, the Netherlands) in 2019. This VFC project aims to optimize care for patients with musculoskeletal injuries. There are two main parts to the VFC project: 1) Direct Discharge (DD) from the Emergency Department (ED) for patients with simple, stable injuries (SSIs), and 2) a daily VFC review for all other ED patients with the aim of documenting an extensive treatment plan for each individual patient.
The thesis consists of seven chapters, six of which are regarding the first part of the VFC project, i.e. DD from the ED of patients with SSIs. The first part contains two chapters and summarizes the current evidence regarding DD. It also shows that internationally, there is still a large practice variation in the treatment of patients with SSIs. The second part contains three chapters and all chapters are based on the comparison of patients with SSIs six months prior to the implementation of DD in OLVG and patients who were discharged directly in the six months thereafter. It shows that DD is a feasible alternative to routine follow-up, decreasing number of follow-up appointments and healthcare costs, without compromise to patient satisfaction or outcome.
The last part contains two chapters. Chapter six shows that results of DD are comparable in another Dutch hospital, i.e. the concept is transferrable. The last chapter, chapter seven, describes the first experiences and results of the implementation of the second part of the VFC project, i.e. a daily VFC review for all patients who were not discharged directly. The results show that such a review can be performed in a time-efficient manner and might contribute to reducing unnecessary or untimely appointments for this patient group.
Further research will be conducted regarding DD, e.g. additional injuries, a more qualitative approach to study patients’ experiences as well as fine-tuning the DD protocols based on patient characteristics. Further research regarding the VFC review is needed to assess future use and value.
The thesis consists of seven chapters, six of which are regarding the first part of the VFC project, i.e. DD from the ED of patients with SSIs. The first part contains two chapters and summarizes the current evidence regarding DD. It also shows that internationally, there is still a large practice variation in the treatment of patients with SSIs. The second part contains three chapters and all chapters are based on the comparison of patients with SSIs six months prior to the implementation of DD in OLVG and patients who were discharged directly in the six months thereafter. It shows that DD is a feasible alternative to routine follow-up, decreasing number of follow-up appointments and healthcare costs, without compromise to patient satisfaction or outcome.
The last part contains two chapters. Chapter six shows that results of DD are comparable in another Dutch hospital, i.e. the concept is transferrable. The last chapter, chapter seven, describes the first experiences and results of the implementation of the second part of the VFC project, i.e. a daily VFC review for all patients who were not discharged directly. The results show that such a review can be performed in a time-efficient manner and might contribute to reducing unnecessary or untimely appointments for this patient group.
Further research will be conducted regarding DD, e.g. additional injuries, a more qualitative approach to study patients’ experiences as well as fine-tuning the DD protocols based on patient characteristics. Further research regarding the VFC review is needed to assess future use and value.
| Original language | English |
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| Qualification | Doctor of Philosophy |
| Awarding Institution |
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| Supervisors/Advisors |
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| Award date | 4 Nov 2022 |
| Print ISBNs | 9789464218206 |
| Publication status | Published - 2022 |
