The adoption of direct discharge in orthopaedic trauma surgery A user-centred evaluation and towards user-centred design

This thesis investigated the implementation and effectiveness of the Direct Discharge (DD) protocol in a Dutch hospital, specifically targeting low-complexity musculoskeletal injuries. Initially launched at the OLVG Hospital, DD aims to optimize patient outcomes and minimize unnecessary hospital visits and help cope with supply and demand mismatches in daily care. The research examined patient- and healthcare professional experiences with DD, evaluates the readiness of orthopedic trauma professionals for eHealth, conducts injury-specific studies, and considers expanding the DD protocol to additional injuries.
The study finds that DD is both feasible and safe for widespread adoption in the Netherlands.
The attitudes of orthopaedic surgery or traumatology-related healthcare professionals toward the usefulness of eHealth are positive. The COVID-19 pandemic facilitated DD’s rapid adoption by disrupting daily workflows and reducing implementation barriers.
In terms of injury-specific findings, DD is as effective as traditional treatments for patients with greenstick or torus wrist fractures, offering comparable satisfaction to rigid immobilization and follow-up. For stable Type B ankle fractures, a removable orthosis provided non-inferior functional outcomes to a cast. However, more specific inclusion criteria are needed before reducing routine follow-up. For first-time anterior shoulder dislocation (FTASD) patients, DD significantly decreases secondary healthcare utilisation without compromising outcomes. Nonetheless, additional research is needed to identify patients who might require follow-up.
Future DD research should prioritise patient-centred design and ongoing evaluation of patients and key stakeholders to enhance adoption and ensure inclusive design.