Optimizing the pathway for simple stable fractures.

Area of Science:

• Trauma care
• Healthcare management
• Health economics

Background:

• General practitioners (GPs) in the Netherlands refer patients with radiologically diagnosed fractures to the emergency department (ED).
• A new care pathway was implemented at Máxima Medical Centre in 2020, redirecting minor trauma patients from the ED to a traumatology outpatient clinic (OC).

Purpose of the Study:

• To investigate the impact of the new care pathway on healthcare consumption and costs for minor trauma patients.
• To compare healthcare utilization and expenses between the new pathway and the traditional ED referral route.

Main Methods:

• Retrospective cohort study comparing patients from August-October 2019 (control) and August-October 2020 (research group).
• Inclusion criteria: fracture diagnosed by a radiologist on GP-requested radiograph during weekdays, 8:30 am - 4:00 pm.
• Outcomes measured: initial hospital visit duration, hospital visit frequency, medical procedures, imaging extent, and healthcare costs.

Main Results:

• A total of 634 patients were included in the study.
• The research group (new pathway) experienced a median reduction of 25 minutes in initial hospital visit duration.
• The new pathway led to one fewer hospital visit per patient, fewer medical procedures, and a cost reduction of €303.40 per patient, with no change in imaging volume.

Conclusions:

• The new care pathway significantly reduces healthcare utilization and associated costs for minor trauma patients.
• Implementing direct referral to a traumatology outpatient clinic (OC) for minor trauma patients offers advantages, including preventing emergency department (ED) overcrowding.
• Direct referral to the traumatology OC is recommended for all minor trauma patients.