The Effect of Digital Team-based Communication on Patient-initiated Telephone Contacts to Hospital After Discharge

Aalborg University Hospital

Status: Completed

Conditions: Orthopaedic Surgery

Treatments: Other: Standard communication pathways after discharge; Other: Digital team-based communication after discharge

Study type: Interventional

Funder types: Other

Identifiers

NCT05601765

2021-219

Details and patient eligibility

About

The aim of this study is to investigate the effects of eDialogue versus standard communication pathways on patient-initiated telephone contacts to the hospital following discharge. Secondary aims are to explore the effect on other patient-initiated contacts after hospital discharge (mail, video, SMS, personal attendance) and, if digital team-based communication can positively affect patients experience of continuity of care.

Full description

Transition of care from hospital to home following orthopaedic surgery pose a significant risk to patient safety. After discharge, patients or primary care providers may need to communicate with the specialized healthcare team at the hospital about symptoms, postoperative complications, rehabilitation, wounds and medication, but are hampered by a fragmented healthcare system with slow communication pathways. Communication through phone often involves several intermediaries and waiting time for both patients and healthcare professionals. The fact that patients and healthcare professionals must be present at the same time is inflexible and disruptive to work processes. However, cross-sectoral communication and collaboration with patients after hospital discharge are prerequisites to achieve high-quality care and good patient outcomes. Review of the literature show that few studies have explored the effects of digital team-based communication with the patient and across sectors to facilitate collaboration and knowledge sharing after discharge. On the basis of findings from a preliminary pilot study suggesting asynchronous digital team-based communication between orthopaedic surgery patients and healthcare professionals across sectors (eDialogue) may be a solution to the existing problems in communication pathways, we initiated this trial.

Enrollment: 70 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Patients are recruited from the following orthopaedic surgery sub-specialties at Aalborg University Hospital:

• Deformity surgery
• Trauma surgery, including fractures of the spine

Inclusion Criteria:

Patients admitted and operated at Aalborg University Hospital, who;

• have complex care needs involving cross disciplinary and cross sectoral care after hospital discharge
• will be discharged to their home
• will need follow-up in the outpatient clinic after discharge

Patients at all ages, but:

• if patient is < 15 years old, the parent(s) will be included in the study as user(s) of LetDialog.
• if patient is 15-18 years old, the patient will be the user in LetDialog and answer the questionnaires to comply with existing Danish legislation Health Act § 17. If the patient wishes, parent(s) can be included as user(s) in LetDialog as well.

Have access to and ability to use a smartphone Have access to NemID (needed to create a GDPR-safe user profile in LetDialog)

Exclusion Criteria:

Patients, who:

• have previously participated in the eDialogue pilot study
• are discharged to a rehabilitation center, nursing home or similar
• do not speak/read Danish or English well enough to understand participant information and use digital communication in Danish or English through LetDialog
• are included in other ongoing randomized controlled trials or prospective follow-up studies in the Orthopaedic Surgery Department at Aalborg University Hospital, where participation could possibly affect the results of these studies

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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70 participants in 2 patient groups

Standard communication pathways after discharge

Active Comparator group

Description:

Patients who need contact within 72 hours of discharge are advised to call the bed section, from where they were discharged. Telephone counseling can be provided by the nurses available at the time of calling (e.g., questions for medical treatment, precautions after surgery etc.). * If deemed relevant, the patient may be asked to appear in person at the ward (e.g., for the examination of wounds). * If more serious conditions are suspected, a doctor or emergency department will be contacted by the nurse for assessment, triage and possibly readmission. Patients who need contact after 72 hours of discharge are advised to call the outpatient clinic, if they have planned attendances here, or alternatively their own general practitioner or home care nurse. Standard communication pathways between healthcare professionals across sectors are electronic correspondences and telephone inquiries.

Treatment:

Other: Standard communication pathways after discharge

Digital team-based communication after discharge

Experimental group

Description:

Patients will be given access to digital communication with their healthcare team across sectors who are involved in their treatment and care after hospital discharge (eDialogue). They will be set up in a messenger-like tool on the day of discharge, and relevant healthcare professionals will be connected. Individually, the patients will define who they would like to involve, and consent is given digitally. The minimum participants for each patient will be the patient and/or their closest relative, the orthopaedic surgeon, a nurse from the outpatient clinic and a secretary. Patients will have access to eDialogue for 60 days after discharge, and the response rate is set to be 24 hours on weekdays. On weekends and public holidays, patients are informed that they cannot expect a response. If the primary healthcare professional is registered to be on vacation or other absence, "substitutes" within the respective health professional groups will be included.

Treatment:

Other: Digital team-based communication after discharge