Health Care Professionals’ Experiences With a Mobile Self-Care Solution for Low Complex Orthopedic Injuries: Mixed Methods Study (Preprint)

Abstract

BACKGROUND To cope with the rising number of trauma patients in an already constrained Dutch healthcare system Direct Discharge (DD) has been introduced in over twenty-five hospitals in the Netherlands since 2019. With DD, no routine follow-up appointments are scheduled after the Emergency Department (ED) visit, and patients are supported by information leaflets, a smartphone application, and a telephone helpline. DD reduces secondary healthcare utilization, with comparable patient satisfaction and primary healthcare utilization. Currently, little is known about the experiences of in-hospital healthcare professionals with DD. OBJECTIVE The aim of this study was to explore the experiences of healthcare professionals with the DD protocol to enhance durable adoption and improve the protocol. METHODS A mixed-method study was conducted parallel to the implementation of DD in three hospitals. Data were collected through a pre-implementation survey, post-implementation survey, and semi-structured interviews. Quantitative data were reported descriptively, and qualitative data using thematic analysis. Outcomes included the Bowen feasibility parameters: implementation, acceptation, preliminary efficacy, demand, and applicability. Pre-implementation expectations were compared with post-implementation experiences. Healthcare professionals involved in the daily clinical care for patients with low-complex, stable injuries were eligible for this study. RESULTS Of the 217 eligible healthcare professionals, 128 started the primary survey, 37 completed both surveys, and 15 participated in semi-structured interviews. Healthcare professionals expressed satisfaction with the DD protocol (median 7.8, IQR 6.8 to 8.9), noting improved information quality and uniformity, reduced outpatient follow-up, and imaging. DD was perceived as safe in its current form, but a feedback system to reassure healthcare professionals that patients had recovered adequately was suggested to improve DD. The introduction of DD had varying effects on workload and job satisfaction among different occupations. Healthcare professionals expressed intentions to continue using DD due to increased efficiency, patient empowerment, and self-management. CONCLUSIONS Healthcare professionals perceive DD as an acceptable, applicable, safe, and efficacious alternative to traditional treatment. A numerical in-app feedback system (e.g., in-application communication tools or recovery scores) could alleviate healthcare professionals’ concerns about adequate recovery and further improve DD protocols. DD can reduce healthcare utilization, which is important in times of constrained resources. Nonetheless, both advantages and disadvantages should be considered while evaluating this type of treatment. In the future, clinicians and policymakers can use these insights to further optimize and implement DD in clinical practice and guidelines. CLINICALTRIAL not applicable to this study