Barriers and Facilitators to Implementation of a Telephone Follow-Up Program for Severely Injured Trauma Patients – A Process Evaluation

Elizabeth Wake*, Caitlin Brandenburg, Kathy Heathcote, Kate Dale, Don Campbell, Magnolia Cardona

*Corresponding author for this work

Research output: Other contributionDiscipline Preprint RepositoryResearch

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Abstract

This preprint is under consideration at BMC Health Services Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.


Background:
Survival rates following major trauma are increasing. Understanding the longitudinal outcomes of major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma centre. This evaluation was conducted to examine what factors promoted or impeded the program’s implementation.

Methods:
A prospective mixed methods process evaluation was conducted alongside the implementation of the follow up program. Quantitative and qualitative data were collected across the evaluation domains: reach, dose, fidelity, context and sustainability and clinical data of program participants (patients); semi-structured interviews with staff delivering the program and patients and caregivers who had participated in the program and direct observations (by researchers) of the program delivery and data

Descriptive statistics and thematic analysis were applied to quantitative and qualitative data respectively.

Results:
274 major trauma patients (ISS ≥ 12) were eligible for follow up. A response rate of over 75% was achieved at both follow -up timepoints, with nurses responsible for the majority of calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls, although over 75% of calls were completed within the designated timeframe.

Staff and patients valued the pre-existing trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient’s recovery, whilst patients felt ‘cared for’ and ‘not forgotten’ post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support.

Although primarily designed as a data collection activity, staff spontaneously developed the program to incorporate clinical follow up processes by providing guidance, advice and referrals to patients who indicated ongoing issues such as pain or emotional problems.

Conclusion:
Telephone follow up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support.
Original languageEnglish
PublisherResearch Square
Number of pages19
DOIs
Publication statusUnpublished - Aug 2021

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